A STUDY OF CLINICAL AND ECHOCARDIOGRAPHIC OUTCOMES OF PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY FOR MITRAL STENOSIS

Abstract

Objective: Toassess clinical and echocardiographic outcomes of mitral stenosis (MS) patients treated with Percutaneous trans-venous mitral commissurotomy (PTMC) with regard to mitral valve area and dyspnea functional class NYHA.

Study Design: A single center, descriptive cross-sectional study.

Place and Duration of Study: Adult Cardiology department of AFIC/NIHD, from 1st Jan 2016 till 31st Dec 2017.

Material and Methods: Fifty patients with severe mitral stenosis were recruited in the study using consecutive sampling technique that underwent PTMC. Wilkin’s scoring system was used to ascertain the appropriateness of these patients for the procedure. The results of the procedure were evaluated using 2-D Echocardiography by tracing mitral valve area via planimetry method 24 hours after PTMC.

Results: There were 86.0% females (n=43) and 14.0% males (n=7) in the study, with mean age 40.3 ± 2.8 years. Age of the patients ranged from 20-79 years. About 44 (88%) patients had rheumatic heart disease. Mean End-diastolic trans-mitral gradient before PTMC was 25.5 ± 2.1mm Hg which reduced to 5.3 ± 1.6 mm Hg after PTMC. Mean mitral valve area prior to PTMC was 0.81 ± 0.1cm2 which became 1.52 ± 0.1cm2 post PTMC. No gross complications like hemodynamically significant hematoma, significant mitral regurgitation or circulatory compromise were noted. Septal punctures were all successful though the balloon could not cross the mitral orifice in one patient, in whom the procedure had to be abandoned. Paired samples t-test was used to assess the statistical significance. The results turned out to be statistically significant (p<0.05) on the basis of area of mitral valve and End-diastolic trans-mitral gradient.

Conclusion: PTMC is a procedure that has quite high success rates and in addition to the favorable outcomes it has a high safety profile when performed in patients who have optimal Wilkin’s scores.