Immediate Impact of Percutaneous Transvenous Mitral Valve Commissurotomy (PTMC) on Right Ventricular Function

Abstract

Background: The aim of this study was to evaluate the immediate impact of Percutaneous Transvenous Mitral Commissurotomy (PTMC) on RV function in patients with mitral stenosis (MS).Methods: This study was conducted in the National Institute Cardiovascular Diseases, Dhaka for a period of one year starting from October 2008 to September 2009. A total of 50 consecutive patients (Case group) with mitral stenosis were selected after considering inclusion and exclusion criteria that subsequently undergone PTMC. The control group (n=50) consisted of age and sex matched healthy individual (having no ECG or echocardiographic evidence of structural or functional cardiovascular disease). Healthy control group was taken because there was no data about RV function in our population. Control group used to compare with baseline characteristics of case group.Results: Immediately after PTMC (24 to 48 hours) mitral valve area increased from 0.8± 0.1 to 2.0 ± 0.2 (p <0.001) and RV outflow tract fractional shortening (RVOTfs % ) increased from 54.9 ± 4.6 to 74.9 ± 4.8% (p <0.001). There was a significant decrease in systolic pulmonary artery pressure from 47.7 ± 7.9mmHg to 28.2 ± 5.9 mmHg (p <0.001), in the RV Tei index from 0.5 ± 0.1 to 0.3 ± 0.1 (p <0.001 ), in myocardial acceleration during isovolumic contraction (IVA) at the lateral tricuspid annulus from 0.4 ± 0.1 m/s² to 0.3 ± 0.0 m/s² (p <0.001). The RVEF (%) did not exhibit any significant change from pre-PTMC figure (p = 0.538).Conclusion: After successful PTMC the parameters of infundibular and global RV function as assessed by RVOTfs and Tei index showed significant improvement and significant decrease in RV contractility as assessed by IVA was observed. Further work using larger numbers of patients is needed to confirm our findings and to assess their utility in patient follow-up and management. DOI: http://dx.doi.org/10.3329/cardio.v5i1.12205 Cardiovasc. j. 2012; 5(1): 3-11

Immediate and midterm impact of percutaneous transvenous mitral valve commisurotomy (PTMC) on right ventricular function

“…These parameters are consistent with other studies done by Drighil et al (2008) and Borges et al (2006) and Kundu et al (2012).…”

“…Right ventricular dysfunction is likely as important as tricuspid regurgitation because it offers an explanation for the negative prognostic The quantitative echocardiographic assessment of RV function is difficult because of the ventricle's complex The mode of clinical presentation in this study shows, 90% patients complained of fatigue, shortness of breath in 85%, palpitation in 65%, chest pain in 28%, ankle edema in 15%, headache among 10% and dizziness in 25%. Another study Kundu et al (2012) reported that the majority (80%) of the patients complained shortness of breath, followed by 64% with palpitation, 30% with cough, 24% with chest pain and 6% with hemoptysis which is consistent with our current study.…”

“…Hemodynamic and radionuclide studies (Burger et al 1997, Hirata 1992 have demonstrated long term improvement in RVF after Percutaneous balloon mitral valvuloplasty (PTMC). Few studies have examined the immediate impact of PTMC on echocardiographic markers of RV systolic and diastolic function 4,7,10 . There is no study showing midterm effect on right ventricular function following PTMC.…”

Correlation of Net Atrioventricular Compliance with the Outcome of Successful Percutaneous Transvenous Mitral Valve Commissurotomy

“…Post PTMC pulmonary artery systolic pressure, though found reduced significantly, still higher than that found in other studies. 26,27 In this study net atrioventricular compliance increased from 3.42 ± 1.64 to 6.38 ± 7.36 ml/ mm of Hg. Aditya Kapoor et al 25 found that left atrial compliance significantly improved immediately after successful balloon mitral valvotomy, irrespective of the pre valvotomy left atrial pressure.…”

Immediate impact of percutaneous transvenous mitral commissurotomy on right ventricular function

“…the study conducted by Drighil et al 8 showed reduction of PASP from 46.4 ± 32.1 mmHg to 29.1 ± 13.4 mmHg ( P = 0.02). Kundu 30 et al showed reduction from 47.7 ± 7.9 to 28.2 ± 5.9 (p<0.001). Similar results were also seen in other studies conducted by Mohan JC et.al.…”