Percutaneous Transvenous Mitral Commissurotomy in Middle Aged Indian Population- A Cross-sectional Study

Abstract

Introduction: Mitral Stenosis (MS) is a chronic complication seen among patients with Rheumatic Heart Disease (RHD). Percutaneous Transvenous Mitral Commissurotomy (PTMC) is a non surgical intervention indicated exclusively for MS with favourable valve morphology. Aim: To determine the outcomes of PTMC in middle aged Indian population in relation to clinical and haemodynamic parameters. Materials and Methods: This retrospective cross-sectional study conducted at a tertiary care hospital in Chennai, Tamil Nadu, between 1994 and 2019. Study was based on analysis of data from 82 patients diagnosed with MS, that underwent successful PTMC. Patients in the age group of 40 to 60 years with symptomatic MS {Mitral Valve Area (MVA) <1.5 cm2 on echocardiogram} were included in this study. Successful PTMC was defined in terms of MVA >1.5 cm2. Participants were divided into two groups based on Wilkins score of 8 as a cut-off. The continuous variables of the study subjects were described and interpreted by averages and compared between the groups by independent t-test. The pre, post and follow-up characteristics were analysed by averages and interpreted by paired t-test and confirmed by repeated measures of ANOVA. Results: Group A with Wilkin’s score ≤8 showed better results in terms of functional status improvement [New York Heart Association (NYHA) classification], MVA, mean gradient across mitral valve and Pulmonary Arterial Pressure (PAP) with p-values <0.05 after a mean follow-up period of one year. Conclusion: Long-term outcomes of PTMC is better in patients with lower Wilkin’s score than those with higher scores in terms of functional status improvement, maintenance of MVA and mitral valve mean gradient pressure. These factors favour the optimal utilisation of PTMC as an alternative to surgery especially among middle aged population.

Frequency of Acute Mitral Regurgitation in Post Percutaneous Transvenous Mitral Commissurotomy (PTMC) Patients with Severe Mitrall Stenosis (MS)

“…[16] Patients with severe mitral stenosis who have undergone the PTMC operation have a high success rate, according to the present research and earlier studies. [26] The risk of mitral regurgitation following surgery may be raised when the mean valvular area and the mitral valve mean gradient pressure are maintained. [27] No problems like localised hematoma or mitral regurgitation or circulatory compromise have been detected by the authors of a local trial done in 2019 at the Combined Military Hospital in Pakistan.…”