Clinical and Echocardiographic Follow-up after Successful Percutaneous Transvenous Mitral Commissurotomy

Abstract

BackgroundThe objective of the study was to determine the long-term outcomes, including mitral restenosis and regurgitation, after successful percutaneous transvenous mitral commissurotomy (PTMC).MethodsThis cross-sectional prospective study was conducted at the cardiology department of Lady Reading Hospital, Peshawar, Pakistan, from January 2007 to December 2009. A total of 84 patients were followed up for a period of 96 months. Pre and post percutaneous transvenous mitral commissurotomy echocardiography was done on the mitral valve area (MVA) using two-dimensional (2D) and color doppler echocardiography. Patients who had successful PTMC were followed up for MVA loss, mitral regurgitation (MR), and cardiac death. SPSS Software (IBM SPSS Statistics for Windows, Version 22.0, Armonk, NY: IBM Corp.; 2013) was used for data analysis.ResultsOf the 84 patients, 21 were male, and 63 were females. The mean age was 35 ± 11 years. After PTMC, the mean valve two-dimensional area increased from 0.84 ± 0.13 to 1.83 ± 0.49 cm2 (p value <0.001). MR was mild in 49 patients (62.8%), moderate in 27 patients (34.6%), and severe in two patients (2.6%). Good results were achieved in 60 (71.4%). Patients with good results were younger (24 ± 4), and had a relatively lower Wilkin's score, with a mean value of (8.4 ± 2.8). Follow-up events were death in six patients, mitral valve replacement (MVR) in 10 patients, and restenosis in seven patients. The Kaplan-Meier curve was used for the follow-up end points. Patient who required PTMC for mitral restenosis survived for a longer time than those requiring MVR, and those who had cardiac death due to severe pulmonary hypertension or heart failure.ConclusionPatients who had favorable Wilkin’s score and underwent PTMC for severe symptomatic mitral stenosis had better event-free survival in the long term follow-up.

Comprehensive echocardiographic and speckle tracking strain analysis in rheumatic mitral stenosis patients before and after transvenous mitral commissurotomy

“…[17][18][19] In term of left ventricular function, there is a notion that MS protects the LV, thus systolic function should be preserved [13]. Many studies have shown that the EF is indeed preserved pre and immediately post PTMC [2][3][4]. Our study further con rms this fact and additionally demonstrates this phenomenon even at 6 months.…”

“…The aim of PTMC is to relief the obstruction across the mitral valve by cracking open the fused commissures, hence the name "commissurotomy" [1]. There are many studies showing signi cant increases in MVA and reduction in mean PG post PTMC [1][2][3]. PTMC is generally associated with good outcomes with low procedural and long-term mortality, but with signi cant need for re-intervention in the future.…”

“…We looked at medical records of all patients who underwent PTMC at our center from 2011 to 2021.All patients included had mitral valve area < 1.5cm 2 . We excluded patients with more than mild mitral regurgitation and those whose echocardiographic images were deemed not suitable for strain analysis.…”

“…Percutaneous Transvenous Mitral Commissurotomy (PTMC) is an established treatment for severe rheumatic mitral stenosis (MS) since its rst publication in 1984 [1]. The aim is to crack the fused commissures thereby increasing the mitral valve area and reducing the mean pressure gradient (mean PG) across the mitral valve [2,3]. Prior studies have shown that the left ventricle (LV) ejection fraction (EF) is preserved in MS and the EF also does not change signi cantly immediately post PTMC [2][3][4].…”

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

“…It is obvious from the literature that in developing countries like India, MS predominantly affects a younger population and the majority of symptomatic MS patients usually present before the age of 30 years and our findings are in agreement with these studies. [151617181920212223] On the other hand, in Western countries, the disease primarily involves the older population as shown in a series of PTMC reported from developed countries. [24] In addition, reports indicate that the progression of symptoms of rheumatic MS in this part of the world is very rapid.…”