Doppler Echocardiographic Assessment of Long-Term Progression of Mitral Stenosis in 103 Patients: Valve Area and Right Heart Disease

Background: Rheumatic heart disease remains the most common acquired heart disease in children, especially in developing countries. This study aims to investigate the predictors of immediate procedural success and the immediate and long-term outcomes in patients undergoing percutaneous mitral commissurotomy (PTMC). Methods: A total of 1552 patients with rheumatic mitral stenosis and underwent PTMC from 1989 to 2012 were identified. We divided the group according to Wilkins score as low risk (≤5), intermediate risk (6-8) and high-risk (≥9). Procedural success was defined as mitral valve area greater than 1.0cm2 with a mean gradient of less than 10mmHg. Results: The median age was 36 years old [IQR 28-45]. The majority of patients was female (78.5%) and did not have any other valve involvements (85.0%). Most of cases were elective (99.5%) although 103 patients were pregnant (6.6%) during PTMC. The mitral valve area increased from 0.8cm2 [IQR 0.7-1.0] pre-procedure to 1.5cm2 [IQR 1.3-1.7] post-procedure, with a reduction in the mean pressure gradient of 15mmHg [IQR 12-20] to 4mmhg [IQR 2-6] post-procedure (all p< 0.05). Using logistic regression analysis, no difference was seen in immediate procedural success between increasing age, previous PTMC, emergency cases, New York Heart Association status, balloon size or increasing risk groups (all p>0.05). During the 15-year follow-up, the majority of patients were still alive. Conclusions: PTMC appears to be safe and effective in our population, irrespective of older age, higher NYHA class, higher Wilkins score and previous PTMC with good immediate and long-term outcomes.

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Mean Levels of B-type Natriuretic Peptide (BNP) in Patients with Mitral Stenosis Caused by Rheumatic Heart Disease

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i60a34460 ◽

2021 ◽

pp. 96-102

Author(s):

Altaf Hussain ◽

Faraz Farooq Memon ◽

Iftikhar Ahmed ◽

Syed Ahsan Raza ◽

Lajpat Rai ◽

...

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

Natriuretic Peptide ◽

Mitral Stenosis ◽

Final Analysis ◽

Severe Intensity ◽

The Mean ◽

Valvular Lesion ◽

Rheumatic Heart ◽

Valve Area

Objective: Mitral stenosis caused by rheumatic heart disease (RHD) is the most common cause of valvular lesion in adults and prevalent in developing countries like Pakistan. Higher natriuretic peptide (BNP) levels can be observed in patients with moderate to severe untreated mitral stenosis and are associated with higher rates of morbidity and mortality. That is why this study aims to determine the association between levels of pro-BNP with severity (mild. Moderate, and severe) of mitral stenosis. Patients and Methods: This was a clinical prospective study carried out in the department of adult cardiology, national institute of cardiovascular diseases, Karachi from 8th august 2019 to 7th February 2020. Total 68 patients of either gender with age between 25-70 years had mitral stenosis of moderate to severe intensity (mitral valve area ≤1.5 cm2), diagnosed on echocardiography were included for final analysis. A simple blood sample was taken for the assessment of pro-BNP levels. Questionnaire was used for demographic & clinical data collection and analysed using SPSS version 22.0. Results: The overall mean age of study subjects was 42.21±11.50 years, ranging from 25 – 70 years. Among them, females were prevalent (n = 43, 63.2%). The overall mean serum BNP level was 1071.12±807.26 pg/ml and the mean difference of serum BNP level was not significant among groups of gender, age, and diabetes mellitus with p>0.05. Significantly raised levels of BNP were observed in patients with severe mitral stenosis as compared to moderate mitral stenosis, p<0.05 Conclusion: In conclusion, the mean BNP levels were higher in patients with severe Mitral Stenosis. Therefore, BNP may be used to complement the clinical and echocardiographic assessments in patients with Mitral Stenosis.

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Abstract 19824: Percutaneous Mitral Balloon Comissurotomy versus Surgical Comissurotomy in the Treatment of Severe Symptomatic Mitral Stenosis

Circulation ◽

10.1161/circ.130.suppl_2.19824 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Rhanderson N Cardoso ◽

Mohammad Ansari ◽

Daniel Garcia ◽

Eduardo De Marchena ◽

Cesar E Mendoza

Keyword(s):

Heart Failure ◽

Mitral Regurgitation ◽

Mitral Stenosis ◽

Meta Analysis ◽

Clinical Results ◽

Short Term ◽

Stage D ◽

Valve Area

Introduction: Percutaneous mitral balloon comissurotomy (PMBC) and surgical comissurotomy can be used for treatment of stage D mitral stenosis. Randomized controlled trials (RCTs) comparing PMBC and surgery have shown inconsistent results. Hypothesis: PMBC is associated with better hemodynamic and clinical results for the treatment of stage D mitral stenosis. Methods: Databases were searched for RCTs that compared double-balloon PMBC to surgical comissurotomy. Inclusion criteria were no left atrial clot, a favorable valve morphology and absence of significant mitral regurgitation. Clinical and hemodynamic outcomes were evaluated within short-term (less than 6 months) and long-term (over 6 months) follow up. Random-effects model was used due to anticipated heterogeneity. Results: A total of 6 RCTs with 474 patients were included, of whom 222 (46.8%) underwent PBMC. In short-term follow up, PMBC was associated with a larger mitral valve area (MVA) compared to surgical comissurotomy (mean difference 0.41 cm2; 95% CI 0.16-0.67; p=0.002; figure 1A), but also a higher incidence of moderate to severe mitral regurgitation (MR; OR 2.63; 95% CI 1.04-6.70; p=0.04; figure 1B). Short-term symptomatic (NYHA II-IV) heart failure (p=0.40) and new MR (p=0.32), as well as long-term MVA (p=0.23), restenosis (p=0.39), symptomatic heart failure (p=0.11), new MR (p=0.64) and need for reintervention (p=0.21) were not significantly different between groups. Conclusions: Our meta-analysis of RCTs suggests that PMBC is associated with an increased MVA as well as a higher incidence of moderate to severe MR when compared to surgery in the treatment of stage D MS. Therefore, the decision to proceed with PMBC or surgery in patients suitable for both procedures must rely on patient preferences, physician experience and risk of procedure-specific complications, such as left-to-right shunt with PMBC and wound infection/dehiscence with surgical comissurotomy.

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