Immediate Results of Percutaneous Trans-Luminal Mitral Commissurotomy in Pregnant Women with Severe Mitral Stenosis

Background Valvular heart diseases and mainly rheumatic heart diseases complicate about 1% of pregnancies. During pregnancy physiological hemodynamic changes of the circulation are the main cause of mitral stenosis (MS) decompensation. Prior to introduction of percutaneous mitral balloon commissuroplasty (PTMC), surgical comissurotomy was the preferred method of treatment in patients with refractory symptoms. PTMC is an established non-surgical treatment of rheumatic mitral stenosis. The study aimed to assess the safety and efficacy of PTMC in pregnant women with severs mitral stenosis. Material and Method Thirty three consecutive patients undergoing PTMC during pregnancy enrolled in this prospective study. Mitral valve area (MVA), transmitral valve gradient (MVG), and severity of mitral regurgitation (MR) were assessed before and 24 hour after the procedure by transthoracic and transesophageal echocardiography. Mitral valve morphology was evaluated before the procedure using Wilkin's criteria. Patient followed for one month and neonates monitored for weight and height and adverse effect of radiation. Result Mitral valve area increased from 0.83 ± 0.13 cm2 to 1.38 ± 0.29 cm2 ( P = 0.007). Mean gradient of mitral valve decreased from 15.5 ± 7.4 mmHg to 2.3 ± 2.3 mmHg ( P = <0.001). Pulmonary artery pressure decreased from 65.24 ± 17.9 to 50.45 ± 15.33 ( P = 0.012). No maternal death, abortion, intrauterine growth restriction was observed and only one stillbirth occurred. Conclusion PTMC in pregnant women has favorable outcome and no harmful effect on children noted.

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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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Two-dimensional transesophageal echocardiographic determination of mitral valve area in adults with mitral stenosis

American Heart Journal ◽

10.1016/0002-8703(94)90055-8 ◽

1994 ◽

Vol 127 (5) ◽

pp. 1348-1353 ◽

Cited By ~ 6

Author(s):

Marcus F Stoddard ◽

Charles R Prince ◽

Nasar M Ammash ◽

John L Goad

Keyword(s):

Mitral Valve ◽

Mitral Stenosis ◽

Two Dimensional ◽

Mitral Valve Area ◽

Valve Area

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Closed Mitral Valvotomy for Mitral Stenosis in Mirror Image Dextrocardia

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239500300211 ◽

1995 ◽

Vol 3 (2) ◽

pp. 75-77 ◽

Cited By ~ 1

Author(s):

Gutti Ramasubrahmanyam ◽

Dronamraju Dilip ◽

Pirovam Venkat Ramnarayan ◽

Raju Subramaniam Iyer ◽

Kothapalle Venugopal Naidu

Keyword(s):

Mitral Valve ◽

Surgical Approach ◽

Mitral Stenosis ◽

Mirror Image ◽

Abnormal Position ◽

Mitral Valve Area ◽

Anterolateral Thoracotomy ◽

Mitral Valvotomy ◽

Valve Area

A 22-year-old female with mirror image dextrocardia and rheumatic valvular mitral stenosis underwent closed mitral valvotomy using a Tubb's dilator with good results. Despite abnormal position of situs, the surgical approach was simple through right anterolateral thoracotomy, and the operator's hands were mirror image to that of levocardia valvotomy in certain steps. Preoperative mitral valve area was 0.8 cm2, and peak and mean diastolic gradients were 21 and 15 mmHg respectively. Postoperatively, valve area improved to 2.16 cm2, and peak and mean diastolic gradients were 8 and 3.1 mmHg, respectively.

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