scholarly journals FREQUENCY OF ACUTE MITRAL REGURGITATION IN POST PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY PATIENTS WITH SEVERE MITRAL STENOSIS

2022 ◽  
Vol 54 (4) ◽  
pp. 328-332
Author(s):  
Zuhaib Uddin ◽  
Zeeshan Shaikh ◽  
Naveed Ahmed Shaikh ◽  
Sanaullah Shaikh ◽  
Gian Chand ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Mitral Stenosis ◽  
Cross Sectional Study ◽  
Severe Mitral Regurgitation ◽  
Cross Sectional ◽  
Post Procedure ◽  
Number Of Patients ◽  
Acute Mitral Regurgitation ◽  
Percutaneous Transvenous Mitral Commissurotomy ◽  
Mitral Commissurotomy

Objectives: To determine the frequency of Acute Mitral Regurgitation in Post Percutaneous Transvenous Mitral Commissurotomy (PTMC) patients with severe mitral stenosis (MS). Methodology: A cross-sectional study was conducted at the Tabba Heart Institute, Karachi, Pakistan between September 2019 and April 2021. All patients irrespective of gender, aged between 19-80 years, and those who did not undergo PTMC were eligible to partake in the study. Patients with mitral regurgitation along with mitral stenosis, or those with clot in left atrium, or those suffering with the last stage of renal disease were excluded from the study. A predefined Proforma was used as a research instrument through which medical records of patients of PTMC are collected. The variables of the Proforma include patient’s age, name, sex, echo findings, treatment procedure, post-procedure data and complications. Results: A mean age of 40.6 ± 12.63 years was reported. 86 (81.9%) of the patients developed ‘no complications’, 15 (14.3%) of the PTMC patients suffered from ‘severe mitral regurgitation’, 2 (1.9%) had local hematoma, and one patient had a cardiac tamponade after the procedure. Only one patient died post-procedure. Post-stratification analysis showed that the majority of the female patients and 83% of the patients with no previous commissurotomy history did not have any complications. While a total of 14.7% who had no history of previous commissurotomy suffered from severe MR. Conclusion: Our study revealed that only a small number of patients who underwent PTMC suffered from severe mitral regurgitation. Overall, the procedure is safe with a good outcome.

scholarly journals IMMEDIATE OUTCOMES OF PERCUTANEOUS TRANSLUMINAL MITRAL COMMISSUROTOMY IN PATIENTS OF MITRAL STENOSIS

1969 ◽  
Vol 4 (1) ◽  
pp. 393-398
Author(s):  
ABDUL WALI ◽  
MUSHTAQ AHMED ◽  
UMAIR ALI ◽  
HIKMATULLAH JAN ◽  
ADNAN MEHMOOD GUL ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Cardiac Tamponade ◽  
Mitral Stenosis ◽  
Cross Sectional Study ◽  
Hospital Death ◽  
Severe Mitral Regurgitation ◽  
Cross Sectional ◽  
Mitral Commissurotomy ◽  
Percutaneous Transluminal ◽  
Percutaneous Transluminal Mitral Commissurotomy

BACKGROUND: Percutaneous Transluminal Mitral Commissurotomy (PTMC) is the treatment ofchoice for mitral stenosis. Patients with valvular calcification, thickened fibrotic leaflets and subvalvularfusion have adverse immediate outcomes of PTMC.OBJECTIVE: To determine the frequency of immediate outcomes of percutaneous transluminal mitralcommissurotomy in patients of mitral stenosis.This is descriptive cross sectional study conducted in the Cardiology Unit Govt. Lady Reading HospitalPeshawar from Jan, 2008- Feb, 2012, five hundreds and seventy seven patients of mitral stenosis.METHODS: Mitral patients with or without pre existing mild mitral regurgitation admitted inCardiology Unit, Lady Reading Hospital, Khyber Teaching Hospital and Hayat Abad Medical ComplexPeshawar were included in the study. After performing PTMC according to the standard protocol, dataregarding failure of the procedure, severe mitral regurgitation, cardiac tamponade, thromboembolismand in-hospital death was recorded.RESULTS: Out of 577 patients, 220 (38.13%) were males and 357 (61.87%) were females. The meanage of the patients was 31.96±10.01 years. Failure of the procedure of PTMC was found in 38 (7%)patients, severe mitral regurgitation in 27 (5%) patients, cardiac tamponade in 1 (0.17%) patients,thromboembolism in 3 (0.52%) patients and In-hospital death occurred in 5 (0.867%) patients.CONCLUSION: PTMC is a safe and effective procedure with good immediate outcomes in patients ofmitral stenosis with favorable mitral valve morphology.KEY WORDS: Mitral stenosis, PTMC, BMV, Outcomes of PTMC.

scholarly journals ASSESSMENT OF COMMISSURAL MORPHOLOGY BY 2-DIMENSIONALAND 3- DIMENSIONAL ECHOCARDIOGRAPHY TO PREDICT THE IMMEDIATE OUTCOME OF PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY IN PATIENTS WITH RHEUMATIC MITRAL STENOSIS

2020 ◽  
pp. 1-3
Author(s):  
Jeet Ram Kashyap ◽  
Kewal Chand Goswami ◽  
Rakesh Yadav ◽  
Ganesan Karthikeyan ◽  
Neeraj Parakh ◽  
...  
Keyword(s):  
Mitral Stenosis ◽  
Three Dimensional ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Cross Sectional ◽  
Rheumatic Mitral Stenosis ◽  
3D Echo ◽  
Percutaneous Transvenous Mitral Commissurotomy ◽  
Mitral Commissurotomy ◽  
Dimensional Echocardiography

OBJECTIVE To find various commissural morphologic predictors of immediate outcome of percutaneous transvenous mitral commissurotomy by two and three dimensional echocardiography. METHODS Design: Cross sectional study Setting: Teratiry care hospital Participants: Symptomatic patients with severe rheumatic mitral stenosis aged more than 12 years without any contraindications for the procedure. Intervention: 2D and 3D echocardiographic evaluation of commissural morphology was done by measuring commissural thickness score, commissural fusion score, commissural calcification and intercommissural distance. End point: Predictors of successful procedure. RESULTS Sixty-five patients were screened. Ten were excluded because of (commissural calcification 5, > moderate mitral regurgitation 2, thrombus in left atrium 2 and emergency procedure in a pregnant lady 1). Fifty five patients (29 (53%) men and 26 (47%) women), mean age 30.58 ± 9.27 were studied. The procedure was successful in 47 (86%) patients. The following parameters predicted the success; lower commissural fusion score by 3D echo 1.5 (0.5 – 2.0) vs. 2.0 (0.5 -2.0); p ≤ 0.002, higher intercommissural distance by 2D echo 19.0 (12.5 – 21.5) vs. 16.5 (12.0 – 18.5); p ≤ 0.009, lesser commissural thickness score 3D echo 5.0 (0.4 – 10.2) vs. 8.8 (3.9 – 10.0); p ≤ 0.028 as well as by 2D echo 5.1 (1.7 - 9.8) vs 8.5 (4.3 - 9.7); p < 0.037. Commissural thickness score by 2D echo was the best predictor of outcome (r=0.509, P<0.0001). CONCLUSIONS Comissural morphology is an important independent predictor of immediate outcome of percutaneous transvenous mitral commissurotomy.

Pathology of Severe Mitral Regurgitation following Balloon Valvuloplasty

1997 ◽  
Vol 5 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Shiv Kumar Choudhary ◽  
Anil Bhan ◽  
Rajesh Sharma ◽  
Balram Airan ◽  
Bhabhananda Das ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Stenosis ◽  
Severe Mitral Regurgitation ◽  
Mitral Leaflet ◽  
Mitral Valvuloplasty ◽  
Mitral Valves ◽  
Posterior Mitral Leaflet ◽  
Radial Tear ◽  
Acute Mitral Regurgitation

This study assessed the mechanism of acute mitral regurgitation following balloon mitral valvuloplasty for the treatment of symptomatic mitral stenosis. We studied 25 patients who required mitral valve replacement for severe mitral regurgitation following balloon mitral valvuloplasty. All the mitral valves studied had features of severe mitral stenosis. Radial tear of the mitral leaflet was responsible for mitral regurgitation in 18 (72%) cases. Of these, 16 involved the anterior mitral leaflet and in 2 cases the posterior mitral leaflet was torn. Three patients (12%) had chordal rupture, whereas in 4 (16%) patients pseudo-orifices were formed. All the excised mitral valves showed significant subvalvular deformity which was underestimated in prevalvuloplasty echocardiography. No other factor was found to be associated with disruption of the valve. Hence, we conclude that cusp deformity and subvalvular pathology are responsible for faulty transmission of forces and improper engagement of the balloon, resulting in disruption of the valvular apparatus. The incidence of severe mitral regurgitation following balloon mitral valvuloplasty might be decreased by appropriate prevalvuloplasty assessment and patient selection.

scholarly journals Percutaneous Transvenous Mitral Commissurotomy in Middle Aged Indian Population- A Cross-sectional Study

2021 ◽  
Author(s):  
Jayanty Venkata Balasubramaniyan ◽  
RH Lakshmi ◽  
Phalgun Badimela ◽  
Jayanty Sri Satyanarayana Murthy
Keyword(s):  
Mitral Valve ◽  
Functional Status ◽  
Indian Population ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Middle Aged ◽  
Cross Sectional ◽  
Percutaneous Transvenous Mitral Commissurotomy ◽  
Mitral Commissurotomy

Introduction: Mitral Stenosis (MS) is a chronic complication seen among patients with Rheumatic Heart Disease (RHD). Percutaneous Transvenous Mitral Commissurotomy (PTMC) is a non surgical intervention indicated exclusively for MS with favourable valve morphology. Aim: To determine the outcomes of PTMC in middle aged Indian population in relation to clinical and haemodynamic parameters. Materials and Methods: This retrospective cross-sectional study conducted at a tertiary care hospital in Chennai, Tamil Nadu, between 1994 and 2019. Study was based on analysis of data from 82 patients diagnosed with MS, that underwent successful PTMC. Patients in the age group of 40 to 60 years with symptomatic MS {Mitral Valve Area (MVA) <1.5 cm2 on echocardiogram} were included in this study. Successful PTMC was defined in terms of MVA >1.5 cm2. Participants were divided into two groups based on Wilkins score of 8 as a cut-off. The continuous variables of the study subjects were described and interpreted by averages and compared between the groups by independent t-test. The pre, post and follow-up characteristics were analysed by averages and interpreted by paired t-test and confirmed by repeated measures of ANOVA. Results: Group A with Wilkin’s score ≤8 showed better results in terms of functional status improvement [New York Heart Association (NYHA) classification], MVA, mean gradient across mitral valve and Pulmonary Arterial Pressure (PAP) with p-values <0.05 after a mean follow-up period of one year. Conclusion: Long-term outcomes of PTMC is better in patients with lower Wilkin’s score than those with higher scores in terms of functional status improvement, maintenance of MVA and mitral valve mean gradient pressure. These factors favour the optimal utilisation of PTMC as an alternative to surgery especially among middle aged population.

Role of Closed Mitral Commissurotomy for Mitral Stenosis: Mid- and Long-term Surgical Outcome of 36 Patients

2005 ◽  
Vol 8 (1) ◽  
pp. 55 ◽  
Author(s):  
Azman Ates ◽  
Yahya �nl� ◽  
Ibrahim Yekeler ◽  
Bilgehan Erkut ◽  
Yavuz Balci ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Stenosis ◽  
Operating Time ◽  
Term Survival ◽  
Long Term Outcome ◽  
Mitral Commissurotomy ◽  
Closed Mitral Commissurotomy

Purpose: To evaluate long-term survival and valve-related complications as well as prognostic factors for mid- and long-term outcome after closed mitral commissurotomy, covering a follow-up period of 14 years. Material and Methods: Between 1989 and 2003, 36 patients (28 women and 8 men, mean age 28.8 6.1 years) underwent closed mitral commissurotomy at our institution. The majority of patients were in New York Heart Association (NYHA) functional class IIB, III, or IV. Indication for closed mitral commissurotomy was mitral stenosis. Closed mitral commissurotomy was undertaken with a Tubbs dilator in all cases. Median operating time was 2.5 hours 30 minutes. Results: After closed mitral commissurotomy, the mitral valve areas of these patients were increased substantially, from 0.9 to 2.11 cm2. No further operation after initial closed mitral commissurotomy was required in 86% of the patients (n = 31), and NYHA functional classification was improved in 94% (n = 34). Postoperative complications and operative mortality were not seen. Follow-up revealed restenosis in 8.5% (n = 3) of the patients, minimal mitral regurgitation in 22.2% (n = 8), and grade 3 mitral regurgitation in 5.5% (n = 2) patients. No early mortality occurred in closed mitral commissurotomy patients. Reoperation was essential for 5 patients following closed mitral commissurotomy; 2 procedures were open mitral commissurotomies and 3 were mitral valve replacements. No mortality occurred in these patients. Conclusions: The mitral valve area was significantly increased and the mean mitral valve gradient was reduced in patients after closed mitral commissurotomy. Closed mitral commissurotomy is a safe alternative to open mitral commissurotomy and balloon mitral commissurotomy in selected patients.

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

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).

scholarly journals POS1274 THERAPEUTIC MANAGEMENT OF RHEUMATOLOGISTS VERSUS OTORHINOLARYNGOLOGISTS OF CERVICOGENIC DIZZINESS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 921.2-922
Author(s):  
M. Yasmine ◽  
K. Maatallah ◽  
H. Ferjani ◽  
W. Triki ◽  
D. Ben Nsib ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Treatment Approach ◽  
Cross Sectional Study ◽  
Treatment Modalities ◽  
Sectional Study ◽  
Cross Sectional ◽  
Standard Assessment ◽  
Number Of Patients ◽  
Cervicogenic Dizziness ◽  
No Gold Standard

Background:The treatment of patients presenting with cervicogenic dizziness (CGD) may be challenging. Indeed, there is no consensual treatment approach for CGD, nor is there no gold-standard assessment for diagnosis.Objectives:Our study aimed to assess the management of CGD by rheumatologists versus otorhinolaryngologists.Methods:We conducted a cross-sectional study including Tunisian doctors dealing with CGD. Rheumatologists (RTO) and otorhinolaryngologists (ORL) were invited to answer a questionnaire via google form about CGD daily management. Outcomes of interest were treatment modalities.Results:The study included 30 RTO and 32 ORL. Most of the doctors (RTO, vs ORL) were females (88.3%, vs 56.3%), aged between 35 and 45 (43.3%, vs 62.5%), and worked at a private practice (33.3%, vs 59.4%). The number of patients diagnosed with CGD by RTO was as follows: 1-2 per year (33.3%), 1-2 per month (18.8%), 1-2 per week (20%), less than one patient a year (10%) and none in 3.3% of cases. The number of patients diagnosed with CGD by ORL was as follows: 1-2 per year (50%), 1-2 per month (33.3%), 1-2 per week (6.2%), less than one patient a year (15.7%) and none (9.4%). Most patients presenting with CGD were females in both groups (93.1%, vs 82.8% respectively) with a mean age between 36 and 65 (79.3%, vs 82.1%). Most of the respondents declared treating patients with CGD (93.1%, vs 79.1%). Regarding treatment modalities, physical therapy was the most prescribed in both specialties (81.5% and 48.3%, respectively). Only RTO (18.5%) prescribed manual therapy. Concerning medical treatment, anti-inflammatory were the most prescribed drugs in both groups (92.6, and 34.5%, respectively). Sixty-seven percent of RTO prescribed anti-vertigo medication. Interestingly, it was the least prescribed drug by ORL (6.9%). Only RTO (59.3%) prescribed Muscle relaxants.Conclusion:Despite the disparities in the management of CGD, physical therapy remains the first prescribed treatment by Tunisian doctors. Further studies are needed to establish a consensus to treat CGD.Disclosure of Interests:None declared

scholarly journals The status of integrated care on the chronic abuse of alcohol response - A cross-sectional study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Moreira de Sousa ◽  
L Lopes ◽  
P Costa ◽  
G Martins-Coelho ◽  
R Capucho
Keyword(s):  
Alcohol Consumption ◽  
Alcohol Abuse ◽  
Negative Impact ◽  
Cross Sectional Study ◽  
Treatment Team ◽  
Health Administration ◽  
Sectional Study ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Index Value

Abstract Background In 2017, the risk-weighted prevalence of alcohol consumption was the health indicator with a more negative impact on the Institute for Health Metrics and Evaluation Sustainable Development Goals Health Index Value in Portugal. According to data from 2012-14, the Alto Tâmega and Barroso (ATB) had the highest value of Years of potential life lost (YPLL) in North Portugal - 4570,1/10.000 people. Liver chronic disease was the specific cause of death that contributed to the value of YPLL - 465,4/10.000 people. Methods A cross-sectional study was conducted with data from the Northern Health Administration and the General Directorate for Intervention on Addictive Behaviours and Dependencies. We compared the number of patients with chronic alcohol consumption (CAC) in 2018, the leading causes of death between 2012-14, the main morbidity causes according to data from primary healthcare (PHC) physicians in 2018 and the number of patients in specialized treatment team (STT) for alcohol abuse treatment in 2018 in ATB. Results In 2018, 2643 patients of ATB had a diagnosis of CAC; only 178 were followed by an STT. Although CAC had a massive influence on YPLL, this was only the 11º cause of morbidity in ATB according to the data from PHC. The number of women with CAC was stable between 2012 (n = 284) and 2018 (n = 291). In the same period, there was an increase of 52,86% of CAC on men (n = 1523 to n = 2348). Even though 18,4% of YPLL due to chronic liver disease happen in women, only 11,2%of the patients with CAC in the PHC are women. Conclusions There is a need for the improvement of CAC diagnosis in PHC, and the improvement of referral of patients to STT and hospital care. Besides, to reach the SDG3, there is the need to work intensely on SDG 17 (partnership for the goals). The Public Health Unit of ATB is organizing Operation PROMETEU to improve communication, institutional collaboration, and monitoring of the existing health activities that are tackling CAC. Key messages The need to integrate data from different healthcare sources for a better analysis on health problems. The urgent need to tackle the alcohol abuse problem in ATB.

Acute Mitral Regurgitation: an important cause of respiratory distress

2016 ◽  
Vol 15 (1) ◽  
pp. 30-32
Author(s):  
Legate Philip ◽  
◽  
Neil Andrews ◽  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Respiratory Distress ◽  
Severe Mitral Regurgitation ◽  
Shortness Of Breath ◽  
Valve Repair ◽  
X Ray ◽  
Clinical Presentations ◽  
Acute Mitral Regurgitation ◽  
Chest X Ray

Acute mitral regurgitation (acute MR) is a rare cause of acute respiratory distress, which can present diagnostic challenges. We present the case of a 57 year old man who developed acute shortness of breath subsequently associated with fever, raised white cells and elevated CRP. Chest x-ray revealed unilateral shadowing and he was treated for pneumonia, despite the finding of severe mitral regurgitation on echo. Failure to respond to antibiotic treatment following 3 weeks on ITU led to the consideration of acute MR as the cause of his symptoms and he responded well to diuretics. He subsequently underwent mitral valve repair. The causes and clinical presentations of this condition are discussed.

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