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

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

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

2020 ◽  
Vol 37 (1) ◽  
Author(s):  
Adnan Khan ◽  
Ihtesham Shafiq ◽  
Muneeb Jan ◽  
Zair Hassan
Keyword(s):  
Mitral Valve ◽  
Ejection Fraction ◽  
Mitral Stenosis ◽  
Ventricular Ejection Fraction ◽  
Valve Morphology ◽  
Rheumatic Mitral Stenosis ◽  
Before And After ◽  
Percutaneous Transvenous Mitral Commissurotomy ◽  
Echocardiographic Assessment ◽  
Mitral Commissurotomy

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.

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.

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).

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