Echocardiographic assessment before and after Percutaneous Transvenous Mitral Commissurotomy in patients with Rheumatic Mitral Stenosis

Objectives: To determine the changes produced in mitral valve morphology after Percutaneous Trans-Venous Mitral Commissurotomy. Methods: Patients with mitral stenosis who underwent PTMC at the cardiology department of Lady Reading Hospital, Peshawar, Pakistan, from 2006-2016 were included in this study. All the data were manually obtained from the electronic medical record (M.F.E.). Wilkin’s echocardiographic scoring system was used to assess the severity of mitral valve thickness, leaflet mobility, valvular calcification, and Subvalvular disease. The student t-test was used for mean comparison. P-value < 0.05 was considered significant. Results: Of the total 229 patients, males were 96(41.9%), and females were 133(58.1%). The mean [SD] age of the patients was 25 ± 11years. The total Wilkin score was 7 ±1.5. 151(65.9%) were in New York Heart Association (NYHA) functional class III, and 78(34.1%) were in NYHA class IV. There was no immediate change after PTMC in systolic myocardial velocities (SV) measured at the lateral tricuspid annulus. The 2D mitral valve area increased from 0.98±0.94 cm2 to 1.78 ± 0.44 cm2 (P=0.001). Left Atrium diameter was 5.16±0.75 mm prior to PTMC, significantly decreased to 4.7± 0.7 mm (p=0.005) after PTMC. Ejection fraction (Left Ventricular Ejection Fraction) changed from 60.45± 8.25 mm Hg to 62.76±10 mm Hg (p=0.001). Mean Right Ventricular Ejection Fraction (RVEF) of patients before PTMC was 48.7 ± 4.7%, did not change significantly immediately after PTMC. Conclusion: PTMC is associated with significant changes in mitral valve morphology in terms of splitting of the fused mitral commissures, increased MVA, improved leaflet excursion, and splitting of the subvalvular structures. doi: https://doi.org/10.12669/pjms.37.1.2446 How to cite this:Khan A, Shafiq I, Jan M, Hassan Z. Echocardiographic assessment before and after Percutaneous Transvenous Mitral Commissurotomy in patients with Rheumatic Mitral Stenosis. Pak J Med Sci. 2021;37(1):104-108. doi: https://doi.org/10.12669/pjms.37.1.2446 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Effect of Mitral Valve Leaflets Excursion on Mitral Valve area after Percutaneous Trans- Venous Mitral Commissurotomy

Cardiovascular Journal ◽

10.3329/cardio.v10i1.34354 ◽

2017 ◽

Vol 10 (1) ◽

pp. 3-7

Author(s):

Md Abdul Mannan ◽

AAS Majumder ◽

Solaiman Hossain ◽

Mohammad Ullah ◽

SNI Kayes

Keyword(s):

Mitral Valve ◽

Mitral Stenosis ◽

Posterior Leaflet ◽

Anterior Leaflet ◽

Valve Morphology ◽

Mitral Valve Area ◽

A Value ◽

Percutaneous Transvenous Mitral Commissurotomy ◽

Mitral Commissurotomy ◽

Valve Area

Background: Aim of our study was to predict the effect of mitral valve leaflets excursion on mitral valve area following percutaneous transvenous mitral commissurotomy PTMC in patients of mitral stenosis.Methods: Total 70 patients with severe mitral stenosis who underwent PTMC were enrolled in the study.Transthoracic echocardiography was done the day before PTMC and 24-48 hours after PTMC. Mitral valve area, anterior and posterior leaflets excursion were recorded. The relation between leaftlet excursion and mitral valve after PTMC was evaluated.Results: Following PTMC there were significant increasein anterior leaflet excursion from 1.9 ± 0.2 to 2.3 ± 0.2cm (p<0.001), posterior leaflet excursion from 1.6±0.2to1.9 ± 0.2cm (p<0.001). Mitral valve areas increased from 0.8 ± 0.1 to1.7 ± 0.2cm²(p<0.001). Both leaflet excursion increased significantly with the increase in mitral valve area till the area reached a value of about 1.5 cm2, after which any further increase in mitral valve area was not associated with any further increase in leaflet excursion.Conclusion: PTMC is associated with immediate significant changes in mitral valve morphology in terms of splitting of fused mitral commissures, increased leaflets excursion and splitting of the subvalvular structures. Post PTMC leaflet excursion increases significantly with the increase in mitral valve area till the area reaches a value of about 1.5 cm2 after which any further increase in mitral valve area is not associated with any further increase in leaflet excursion.Cardiovasc. j. 2017; 10(1): 3-7

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Echocardiographic assessment of mitral valve morphology after Percutaneous Transvenous Mitral Commissurotomy (PTMC)

Cardiovascular Ultrasound ◽

10.1186/1476-7120-5-48 ◽

2007 ◽

Vol 5 (1) ◽

Cited By ~ 5

Author(s):

Hosam Hasan-Ali ◽

Hamdy Shams-Eddin ◽

Alaa A Abd-Elsayed ◽

Muhammad H Maghraby

Keyword(s):

Mitral Valve ◽

Valve Morphology ◽

Percutaneous Transvenous Mitral Commissurotomy ◽

Echocardiographic Assessment ◽

Mitral Commissurotomy

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Mid-term (up to 12 years) clinical and echocardiographic outcomes of percutaneous transvenous mitral commissurotomy in patients with rheumatic mitral stenosis

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02175-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yahya Dadjo ◽

Maryam Moshkani Farahani ◽

Reza Nowshad ◽

Mohsen Sadeghi Ghahrodi ◽

Alireza Moaref ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Stenosis ◽

Protective Factor ◽

Cardiac Events ◽

Mitral Valve Area ◽

Adverse Cardiac Events ◽

Percutaneous Transvenous Mitral Commissurotomy ◽

Mitral Commissurotomy ◽

Valve Area

Abstract Background Rheumatic heart disease (RHD) is still a concerning issue in developing countries. Among delayed RHD presentations, rheumatic mitral valve stenosis (MS) remains a prevalent finding. Percutaneous transvenous mitral commissurotomy (PTMC) is the intervention of choice for severe mitral stenosis (MS). We aimed to assess the mid-term outcome of PTMC in patients with immediate success. Methods In this retrospective cohort study, out of 220 patients who had undergone successful PTMC between 2006 and 2018, the clinical course of 186 patients could be successfully followed. Cardiac-related death, undergoing a second PTMC or mitral valve replacement (MVR) were considered adverse cardiac events for the purpose of this study. In order to find significant factors related to adverse cardiac outcomes, peri-procedural data for the studied patients were collected.The patients were also contacted to find out their current clinical status and whether they had continued secondary antibiotic prophylaxis regimen or not. Those who had not suffered from the adverse cardiac events were additionally asked to undergo echocardiographic imaging, in order to assess the prevalence of mitral valve restenosis, defined as mitral valve area (MVA) < 1.5 cm2 and loss of ≥ 50% of initial area gain. Results During the mean follow-up time of 5.69 ± 3.24 years, 31 patients (16.6% of patients) had suffered from adverse cardiac events. Atrial fibrillation rhythm (p = 0.003, HR = 3.659), Wilkins echocardiographic score > 8 (p = 0.028, HR = 2.320) and higher pre-procedural systolic pulmonary arterial pressure (p = 0.021, HR = 1.031) were three independent predictors of adverse events and immediate post-PTMC mitral valve area (IMVA) ≥ 2 cm2 (p < 0.001, HR = 0.06) was the significant predictor of event-free outcome. Additionally, follow-up echocardiographic imaging detected mitral restenosis in 44 patients (23.6% of all patients). The only statistically significant protective factor against restenosis was again IMVA ≥ 2 cm2 (p = 0.001, OR = 0.240). Conclusion The mid-term results of PTMC are multifactorial and may be influenced by heterogeneous peri-procedural determinants. IMVA had a great impact on the long-term success of this procedure. Continuing secondary antibiotic prophylaxis was not a protective factor against adverse cardiac events in this study. (clinicaltrial.gov registration: NCT04112108).

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PT102 Immediate Clinical and Echocardiographic Outcome of Percutaneous Transvenous Mitral Commissurotomy In Patients With Rheumatic Mitral Stenosis With Impaired Left Ventricular Systolic Function

Global Heart ◽

10.1016/j.gheart.2014.03.1889 ◽

2014 ◽

Vol 9 (1) ◽

pp. e186

Author(s):

Md.Toufiqur Rahman ◽

Md. Afzalur Rahman ◽

Md. Murshidur Rahman Khan

Keyword(s):

Mitral Stenosis ◽

Systolic Function ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Ventricular Systolic Function ◽

Rheumatic Mitral Stenosis ◽

Percutaneous Transvenous Mitral Commissurotomy ◽

Mitral Commissurotomy

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Assessment of RV function following Percutaneous Transvenous Mitral Commissurotomy (PTMC) for rheumatic mitral stenosis

Journal of Cardiovascular Disease Research ◽

10.5530/jcdr.2016.2.1 ◽

2016 ◽

Vol 7 (2) ◽

pp. 58-63

Author(s):

Huliyurdurga Srinivasa Setty Natraj Setty ◽

Veeresh Patil Hebbal ◽

Yeriswamy Mogalahalli Channabasappa ◽

Santosh Jadhav ◽

Kandenahalli Shankarappa Ravindranath ◽

...

Keyword(s):

Mitral Stenosis ◽

Rheumatic Mitral Stenosis ◽

Percutaneous Transvenous Mitral Commissurotomy ◽

Mitral Commissurotomy ◽

Rv Function

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Comprehensive Echocardiographic and Speckle Tracking Strain Analysis in Rheumatic Mitral Stenosis Patients before and after Transvenous Mitral Commissurotomy

10.21203/rs.3.rs-1041308/v1 ◽

2021 ◽

Author(s):

Aslannif Bin Roslan ◽

Faten A Aris ◽

Tey Yee Sin ◽

Afif Ashari ◽

Abdul A Shaparudin ◽

...

Keyword(s):

Right Ventricle ◽

Mitral Stenosis ◽

Global Longitudinal Strain ◽

Strain Analysis ◽

Right Ventricle Dysfunction ◽

Rheumatic Mitral Stenosis ◽

Significant Difference ◽

Before And After ◽

Mitral Commissurotomy ◽

2D Echocardiogram

Abstract PurposePercutaneous Transvenous Mitral Commissurotomy (PTMC) is the first line treatment for rheumatic mitral stenosis (MS). We sought to evaluate 1) changes in 2-dimensional (2D) echocardiographic and strain values and 2) differences in these values for patients in atrial fibrillation (AF) and sinus rhythm (SR) pre, immediately and 6 months post PTMC.MethodsRetrospective study of 136 patients who underwent PTMC between 2011 and 2021. We analyzed their 2D echocardiogram, Global Longitudinal Strain (GLS), Left Atrial Reservoir Strain (LAr-S) and Right Ventricle Free Wall Strain (RVFW-S) pre, immediately and 6 months post PTMC.ResultsAt 6 months, mitral valve area increases from 0.94 ± 0.23cm2 to 1.50 ± 0.42cm2. Ejection fraction (EF) did not change post PTMC (pre; 55.56 ± 6.62%, immediate; 56.68 ± 7.83%, 6 months; 56.28 ± 7.00%, p=0.218). Even though EF is preserved, GLS is lower pre-procedure; -11.52 ± 3.74% with significant improvement at 6 months; -15.16 ± 4.28% (p<0.001). Tricuspid annular plane systolic excursion (TAPSE) improved at 6 months from 1.95 ± 0.43 to 2.11 ±0.49 (p=0.004). RVFW-S increases at 6 months from -17.37 ± 6.03% to -19.75 ± 7.19% (p<0.001). LAr-S improved from 11.23 ± 6.83% pre PTMC to 16.80 ± 8.82% at 6 months (p<0.001) post PTMC. Pre-procedure patients with AF have lower strain values (More LV, RV and LA dysfunction) with statistically significant difference for LAr-S (p < 0.001), GLS (p <0.001) and RVFW-S (p <0.001) than patients in SR.ConclusionPatients with severe rheumatic MS have subclinical left and right ventricle dysfunction despite preserved EF and relatively normal TAPSE with significant improvement seen at 6 months post PTMC. AF patients have lower baseline strain values than SR patients.

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