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

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.

Can Severity of Pulmonary Hypertension Affect Success Rate of Balloon Mitral Commissurotomy?

Introduction: Rheumatic heart disease is responsible for the most prevalent pathological causes of mitral stenosis and is closely coupled with pulmonary hypertension. Balloon mitral commissurotomy as an alternative method for mitral valve replacement leads to a reduction in pulmonary pressure. All grades of pulmonary hypertension usually regress after mitral commissurotomy; however, the insignificant changes of pulmonary artery hypertension following balloon mitral valvuloplasty are not uncommon. Methods: This retrospective observational study was carried out on 160 patients with significant symptomatic mitral stenosis (mitral valve area [MVA] <1.5 cm ) who underwent successful percutaneous transvenous mitral commissurotomy (PTMC) within 2016-2020 at Shaheed Rajaie Cardiovascular, Medical and Research Center, Tehran, Iran. Results: In this study, 89.4% of the patients were female, and the mean age of the participants was 47.2±12.4 years. Most (74%) patients presented with dyspnea on exertion functional class II. The mean basic MVA was 1±0.20 cm that increased to 1.43±0.23 cm , and the mean basic systolic pulmonary artery pressure (PAP) was 43.84±11.93 mmHg that decreased to 35.13±7.7 mmHg. Persistent PAP after successful PTMC was observed in 34% of the patients. This group of patients showed smaller MVA gain and PAP reduction after the procedure. Pulmonary vascular resistance (PVR) > 2 Wood units was correlated to 91.7% of the post-procedural success rate. Conclusion: The PTMC plays an important role in the reduction of PAP; nevertheless, the chronicity and severity of PAP can lead to persistent pulmonary hypertension. The assessment of initial PAP and basic PVR can help select patients with more likely intended results.

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

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.