Echocardiographic assessment before and after Percutaneous Transvenous Mitral Commissurotomy in patients with Rheumatic Mitral Stenosis

Khan, Adnan; Shafiq, Ihtesham; Jan, Muneeb; Hassan, Zair

doi:10.12669/pjms.37.1.2446

Cited by 6 publications

(9 citation statements)

References 22 publications

(13 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Some reports reject any association between mitral valve score and clinical outcomes or echocardiographic ndings after PMV (15,19). Many Previous studies suggested that the mitral valve Wilkins score is related to clinical and procedural outcomes (20)(21)(22). Some studies have indicated that the optimal Wilkins score for PMV is 8 or below (21), which is consistent with our ndings, and also some studies have shown that a higher Wilkins score is associated with more MVA loss in follow-up (23,24).…”

Section: Discussionsupporting

confidence: 81%

Effect of Commissural Calcification on Clinical Outcomes of Percutaneous Mitral Valvuloplasty

Mazaherinia

Hamidabad

Rostambeigi

et al. 2022

Preprint

View full text Add to dashboard Cite

Background Percutaneous mitral valvuloplasty (PMV) is a safe and widely used treatment in patients with symptomatic rheumatic mitral stenosis. This study aimed to evaluate short-term and mid-term outcomes of PMV in patients with severe mitral stenosis and the effect of commissural calcifications on the outcomes. Methods Medical records of 961 patients after PMV were reviewed. All patients were evaluated using transthoracic echocardiography before and after 24 hours. Patients were divided into three subgroups based on their Wilkins score (group I: score ≤8, group II: score 9-10, and group III: score 11-12). Also, patients were divided into two subgroups based on the presence or absence of commissural calcification. Patients were evaluated before PMV, 24 hours after the procedure and were followed for 6 and 24 months to evaluate the short-term and mid-term outcomes. The echocardiographic measures (mitral valve area, indexed mitral valve index, mitral valve mean gradient, and pulmonary artery systolic pressure) were compared after PMV, and at 6 months and 24 month follow-ups. Main clinical outcomes (moderate and severe mitral regurgitation and restenosis) were compared between patients with and without commissural calcifications. Results:Mean age of the patients was 46.6 ± 12.2, and 81.7 % of patients (n=785) were females. Groups I, II, and III (based on Wilkins score) consisted of 353 (36.7%), 559 (58.1%), and 49 (5%) patients, respectively. Mitral valve area (MVA) and indexed MVA increased significantly in all three groups; in both short-term and mid-term follow-ups (p<0.0001). The rate of mitral valve restenosis was significantly higher in groups II and III compared to group I (P=0.0001), but the rate of significant mitral regurgitation (MR) (defined as >moderate MR) did not differ statistically between the three groups. Commissural calcification was present in 190 patients (19.77%). Restenosis was significantly higher in the presence of commissural calcification (p<0.0001). Also, the occurrence of significant MR was significantly higher in patients with commissural calcification (P=0.03). Conclusion Both Wilkins score and presence of commissural calcification are associated with a higher incidence of mitral valve restenosis. While there is no strong association between higher Wilkins scores and higher rates of significant mitral regurgitation, commissural calcification is associated with a higher rate of severe mitral regurgitation.

show abstract

Section: Discussionsupporting

confidence: 81%

Effect of Commissural Calcification on Clinical Outcomes of Percutaneous Mitral Valvuloplasty

Mazaherinia

Hamidabad

Rostambeigi

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…[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.…”

Section: Discussionsupporting

confidence: 77%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…As a result of the hemodynamic sequelae and back pressure from the obstructed mitral valve, patients with severe rheumatic MS commonly have increase in s-PAP [2,3]. Despite this, many studies have shown that the TAPSE is still above the cut-off for abnormal values based on the American Society of Echocardiography guidelines (Abnormal TAPSE < 1.7) [22,23].…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Roslan

Aris

Sin

et al. 2022

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

Percutaneous Transvenous Mitral Commissurotomy (PTMC) is the rst line treatment for rheumatic mitral stenosis (MS). We sought to evaluate 1) changes in 2-dimensional (2D) echocardiographic and strain values and 2) differences in these values for patients in atrial brillation (AF) and sinus rhythm (SR) pre, immediately and 6 months post PTMC. MethodsRetrospective study of 136 patients who underwent PTMC between 2011 and 2021. We analyzed their 2D echocardiogram, Global Longitudinal Strain (GLS), Left Atrial Reservoir Strain (LAr-S) and Right Ventricle Free Wall Strain (RVFW-S) pre, immediately and 6 months post PTMC. ResultsAt 6 months, mitral valve area increases from 0.94 ± 0.23cm 2 to 1.50 ± 0.42cm 2 . Ejection fraction (EF) did not change post PTMC (pre; 55.56 ± 6.62%, immediate; 56.68 ± 7.83%, 6 months; 56.28 ± 7.00%, p=0.218). Even though EF is preserved, GLS is lower pre-procedure; -11.52 ± 3.74% with signi cant improvement at 6 months; -15.16 ± 4.28% (p<0.001). Tricuspid annular plane systolic excursion (TAPSE) improved at 6 months from 1.95 ± 0.43 to 2.11 ±0.49 (p=0.004). RVFW-S increases at 6 months from -17.37 ± 6.03% to -19.75 ± 7.19% (p<0.001). LAr-S improved from 11.23 ± 6.83% pre PTMC to 16.80 ± 8.82% at 6 months (p<0.001) post PTMC. Pre-procedure patients with AF have lower strain values (More LV, RV and LA dysfunction) with statistically signi cant difference for LAr-S (p < 0.001), GLS (p <0.001) and RVFW-S (p <0.001) than patients in SR. ConclusionPatients with severe rheumatic MS have subclinical left and right ventricle dysfunction despite preserved EF and relatively normal TAPSE with signi cant improvement seen at 6 months post PTMC. AF patients have lower baseline strain values than SR patients.

show abstract

Impact of commissural calcification on clinical outcome of percutaneous balloon mitral valvuloplasty; a retrospective cohort study of 876 patients

Rostambeigi,

Mazaherinia,

Hamidabad

et al. 2024

BMC Cardiovasc Disord

View full text Add to dashboard Cite

Background Percutaneous balloon mitral valvuloplasty (PBMV) is the ACC/AHA class I recommendation for treating symptomatic rheumatic mitral stenosis with suitable valve morphology, less than moderate MR and absence of left atrium clot. The mitral valve restenosis and significant mitral regurgitation (MR) are known adverse outcomes of PBMV. This study aimed to evaluate the outcomes of PBMV in patients with severe mitral stenosis and the effect of Commissural Calcification (CC) on the outcomes. Methods In this single-center retrospective cohort study, 876 patients who underwent PBMV were categorized into three groups based on their Wilkins score (Group I: score ≤ 8, Group II: score 9–10, and Group III: score 11–12). Patients were evaluated before, early after PBMV and at 6- and 24-month follow-ups. Main clinical outcomes were defined as significant restenosis and or symptomatic significant MR (moderate to severe and severe MR) or candidate for mitral valve replacement (MVR). The outcomes were compared between patients with and without CC. Results A total of 876 patients with mean age 46.4 ± 12.3 years (81.0% females) were categorized based on Wilkins score. 333 (38.0%) were in Group I, 501 (57.2%) were in Group II, and 42 (4.8%) were in Group III. CC was present in 175 (20.0%) of the patients, among whom 95 (54.3%) had calcification of the anterolateral commissure, 64 (36.6%) had calcification of the posteromedial commissure, and in 16 (9.1%) patients both commissures were calcified. There was a significant difference in Wilkins score between patients with and without CC (P < 0.001). CC was associated with higher odds of significant symptomatic MR at early and mid-term follow up (OR: 1.69, 95%CI 1.19–2.41, P = 0.003; and OR: 3.90, 95%CI 2.61–5.83, P < 0.001, respectively), but not with restenosis (P = 0.128). Wilkins Groups II and III did not show higher odds of significant symptomatic MR compared to Group I at early (II: P = 0.784; III: P = 0.098) and mid-term follow up (II: P = 0.216; III: P = 0.227). Patients in Wilkins Group II had higher odds of restenosis compared to Group I (OR: 2.96,95%CI: 1.35–6.27, P = 0.007). Conclusion Commissural calcification (CC) is an independent predictor of the significant symptomatic MR (an important determinant of adverse outcome) following PBMV in the early and mid-term follow-up. Mitral valve restenosis occurs more in patients with higher Wilkins score compared to group I with score ≤ 8. Combined Wilkins score and CC should be considered for patient suitability for PBMV.

show abstract

Echocardiographic assessment before and after Percutaneous Transvenous Mitral Commissurotomy in patients with Rheumatic Mitral Stenosis

Cited by 6 publications

References 22 publications

Effect of Commissural Calcification on Clinical Outcomes of Percutaneous Mitral Valvuloplasty

Effect of Commissural Calcification on Clinical Outcomes of Percutaneous Mitral Valvuloplasty

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

Impact of commissural calcification on clinical outcome of percutaneous balloon mitral valvuloplasty; a retrospective cohort study of 876 patients

Contact Info

Product

Resources

About