EMERGENCY SURGERY AFTER FAILED PERCUTANEOUS TRANSMITRAL COMMISSUROTOMY (PTMC) AT ARMED FORCES INSTITUTE OF CARDIOLOGY (AFIC)
Objective: The aim of this study was to analyze the outcome of emergency after PTMC.
Design: A cross-sectional study.
Place and Duration of Study: Armed Forces Institute of Cardiology (AFIC) Rawalpindi from January 2005 to June 2009.
Patients and Methods: A cross-sectional study of 12 patients (2.3%) out of 523 who underwent PTMC and developed significant mitral regurgitation (MR) or cardiac tamponade (CT) was examined to analyze the outcome of emergency surgery. Transthoracic echocardiography (TTE) was used to select patients of MS with minimal calcification and transesophageal echocardiography (TEE) was used to rule out left atrial (LA) clot. Inuoe balloon was used in all cases for PTMC.
Results: Out of twelve who presented for surgery after failed PTMC, 9 (75%) had significant MR and 3 (25%) had CT. Majority of patients were female (83.3%) with mean age of 30.9 ± 5.12 years. In patients with MR, anterior mitral leaflet (AML) tear was found in 8 (66.7%) and posterior mitral leaflet tear in 1 (8.3%). LA clot was found in 1 (8.3%) patient who caused cerebral infarction. All patients underwent mitral valve replacement (MVR) with prosthetic valve on cardiopulmonary bypass (CPB). Two patients (16.7%) died; one because of cerebral infarction and one due to low cardiac output syndrome (LCOS).
Conclusion: With increasing experience of PTMC the magnitude of failure cases is decreasing as was seen in our case in which failed percentage was just 2.3%. Moreover, percentage of success of emergency surgery was good i.e. 83.3%. In case of failure a well coordinated effort between cardiologist and surgical team can prevent mortality significantly.