Percutaneous Transmitral Commissurotomy (Ptmc); Procedural Success and Immediate Results, a Tertiary Care Hospital Experience From Developing Country

Asghar, Naeem; Riaz, Rehan; Hussain, Maqbool

doi:10.17957/tpmj/16.3232

Cited by 4 publications

(8 citation statements)

References 12 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Beg

Younas

Mahmood

et al. 2021

PAFMJ

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Objectives: Immediate result of PTMC in juvenile (5-12 years) rheumatic mitral stenosis. Study Design: Observational descriptive and retrospective study. Place and Duration of Study: Institute of Cardiology, Multan from 2009 to Jun 2020. Methodology: This is an observational descriptive and retrospective study carried out at Institute of Cardiology, Multan from 2009 to Jun 2020. Patients with clinical evidence of significant mitral stenosis were undergone transthoracic echocardiography. Mitral stenosis was defined as mitral valve area <1.0 cm2 . Mean mitral valve gradient was calculated by mitral valve inflow velocities. Patients with Wilkins score <8 were included. Patients with significant MR, left atrial or atrial appendage clot, infective endocarditis, significant aortic regurgitation or any other indication for bypass surgery were excluded. Patients with Wilkins score >8 were also excluded from the study. Variables recorded on a performa were age, weight, left atrial size, mean mitral valve gradient, preprocedure MR. Reduction of mitral valve mean pressure gradients to less than <50% of the initial value was defined as success (without significant or moderate MR). After the procedure, variables recorded on performa were mean left atrial pressures in mmHg (on angio), mean mitral valve gradients and degree of MR (mild, mild to moderate, moderate or severe MR) on transthoracic echocardiography. Paired t-test of significance (p<0.05) was evaluated using SPSS (version 20). Results: Forty three juvenile patients were included the in the study (2009 to June 2019). Mean age was 10.8 ± 1.4 (range 7-12) years. Mean weight was 28.9 ± 5.2 (20-37) kg. Mean mitral valve gradient (on TTE) before the procedure was 20 ± 6 mmHg. Mean left atrial size and mean area of mitral valve were 42 ± 5 mm and 0.8 ± 0.2 cm2 respectively. Balloon sizes used were 26 mm (n=19) and 24 mm (n=24). After PTMC, mean mitral valve reduced to 7 ± 2 mmHg (p<0.005) and left atrial pressure to 18 ± 7 mmHg. Post procedure transthoracic echocardiography showed 4.7% (n=2/43) patients developed moderate to severe or severe MR. So the success rate was 95.3% (n=41/43). Conclusion: PTMC is safe and effective procedure for juvenile patients with mitral stenosis. Long term follow-up is needed to find out period of re-intervention/surgery free duration from the time of PTMC.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: S800mentioning

confidence: 99%

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

Beg

Younas

Mahmood

et al. 2021

PAFMJ

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…The present study reported statistically significant difference between pre- and post-procedure MVA (cm 2 ) after PTMC (0.83 ± 0.08 vs. 1.61 ± 0.07). According to Munir et al .,[21] Adhikari et al .,[18] Ali et al .,[19] and Sharma et al .,[29] PTMC significantly directly increases the rate of perioperative MVA (cm 2 ) as 0.92 ± 0.39 vs. 1.48 ± 0.29, 0.8 ± 0.1 vs. 1.6 ± 0.2, 0.684 ± 0.1226 vs. 1.533 ± 0.281, and 0.87 ± 0.13 vs. 1.63 ± 0.19, respectively. The results of the present study are similar to the above results.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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“…[4][5] In Pakistan 2 rheumatic fever prevalence is 22/1000 that has placed Pakistan among one of the top list countries in the world. 6 Age related degenerative valve disease (DVD) is common in developed countries particularly in the older population as a result of improvement in life expectancy. 7 Patients of VHD going for surgery may have concomitant asymptomatic obstructive CAD.…”

Section: Introductionmentioning

confidence: 99%

Frequency of obstructive coronary artery disease in patients undergoing valvular heart disease surgery.

Ahmad

Yasir

Saeed

et al. 2020

TPMJ

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Objectives: To determine the frequency of obstructive coronary artery disease in patients undergoing valvular heart disease surgery. Study Design: Cross-sectional study. Setting: Department of Cardiology, Faisalabad Institute of Cardiology, Faisalabad. Period: Six months, from 02 February, 2017 to 01 August, 2017. Material & Methods: After taking approval from hospital ethical committee, patients coming through outpatient department who fulfilled the inclusion criteria were enrolled and informed consent was taken from them. History of smoking, diabetes mellitus, renal dysfunction, dyslipidemia, hypertension and family history of coronary artery disease was assessed. Coronary angiography was performed by senior consultant interventional cardiologist for assessing obstructive coronary artery disease as per operational definition. All the information was collected on prespecified Performa. Results: In this study, out of 140 cases of valvular heart disease (VHD), 47.14%(n=66) were between 30-50 years of age whereas 52.86%(n=74) were between 51-70 years of age, mean ±sd was calculated as 51.71+9.09 years, 57.14%(n=80) were male while 42.86%(n=60) were female, frequency of obstructive coronary artery disease in patients undergoing valvular heart surgery was recorded as 29.3% (n=41) whereas 70.7% (n=99) had no such finding. Conclusion: The frequency of obstructive coronary artery disease was (29.3%) in patients undergoing valvular heart disease surgery. However, coronary artery disease was less frequent in rheumatic as compared to degenerative heart valve disease.

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Percutaneous Transmitral Commissurotomy (Ptmc); Procedural Success and Immediate Results, a Tertiary Care Hospital Experience From Developing Country

Cited by 4 publications

References 12 publications

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

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

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

Frequency of obstructive coronary artery disease in patients undergoing valvular heart disease surgery.

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