Assessment of quality of life before and after successful percutaneous transvenous mitral commissurotomy in patients with severe mitral stenosis

Abstract

Background:Rheumatic mitral stenosis (MS) is a significant cause of morbidity and mortality in India. Percutaneous transvenous mitral commissurotomy (PTMC) has become the procedure of choice for severe MS with pliable leaflets. Despite a wealth of literature on the technical aspects of PTMC, there is a dearth of literature addressing the impact of PTMC on the quality of life (QOL).Aim:The aim of the study is to assess the impact of PTMC on clinical status and QOL of patients with severe MS.Materials and Methods:Twenty-five consecutive patients with severe MS undergoing PTMC were included in the study with their informed consent. All patients were subjected to routine blood tests, electrocardiogram, chest X-ray, two-dimensional and color echocardiography, treadmill test (TMT), and World Health Organization (WHO) QOL scale. The echocardiography, TMT, and WHOQOL scale were repeated after the procedure.Results:The procedural success was 98%. The mean (range) mitral valve area preprocedure was 0.82 (0.59–0.92) cm2 and postprocedure was 1.61 (1.51–1.76) cm2. The difference was statistically significant (t = 5.02; P < 0.01). The mean (range) of TMT preprocedure was 4.05 (3.0–7.0) METS and postprocedure was 8.52 (6–12) METS. The difference was statistically significant (T = 3.08; P < 0.01). The mean (range) of QOL assessment pre- and post-procedure on physical domain was 8.83 (8.3–10.1) which increased to 11.11 (10–12.7); on social relationship domain from 9.17 (7.5–12.4) to 11.37 (9.4–12.0); on personal relationship from 11.6 (11–13) to 12.52 (12–13); on environment domain from 10.78 (10.2–11.7) to 11.56 (10.8–12); and on level of independence from 9.02 (8–10) to 12.29 (11.0–13.6). All the differences were statistically significant (Wilcoxon signed-rank test z = −4.376; −4.379; −4.234; −4.200; −4.375; respectively, all P < 0.001 highly significant).Conclusions:PTMC resulted in a significant improvement in the QOL of patients with severe MS. The significant improvement in QOL post-PTMC may be an indication for offering PTMC at an earlier stage to those patients whose QOL is severely compromised.

Percutaneous Transmitral Commissurotomy - Clinical and Echocardiographic Follow-up in Severe Mitral Stenosis

“…PTMC should be considered the treatment of choice in patients with severe mitral stenosis and favorable valve anatomy in all age groups. [15][16][17][18][19] It is a valuable treatment in developing countries where the majority of the patients have severe disease at a young age and may require repeat intervention. The surgical risk can be minimized significantly if PTMC is opted for the treatment.…”

“…The surgical risk can be minimized significantly if PTMC is opted for the treatment. [15][16][17][18][19] http://www. pakheartjournal.com This study does not include patients with suboptimal PTMC results.…”

Immediate Results of Percutaneous Trans-Mitral Commissorotomy in Juvenile Mitral Stenosis

“…PTMC is effective therapy for mitral stenosis. Severe authors have reported the results in adult patients 9,10,11 . However none of local experience for juvenile patients is not reported.…”

“…AHA/ACC has described PTMC as class I indication for rheumatic MS with favorable mitral valve (MV) morphology 8 . Several local authors have published their results in adults [9][10][11] . No local study has reported the immediate results in children (<12 years) with severe MS.…”

Extra cardiac perforation following failed percutaneous transvenous mitral commissurotomy

“…4 Complications requiring emergency surgery include acute, severe mitral regurgitation following mitral valve apparatus disruption and cardiac tamponade induced by the perforation of cardiac chamber. 5 We present the case of an emergency mitral valve replacement with extra-cardiac perforation repair after a failed PTMC in which the guide wire and sheath traversed an aberrant path and perforated the ascending aorta.…”