IMMEDIATE RESULTS OF PERCUTANEOUS TRANS-MITRAL COMMISSOROTOMY IN JUVENILE MITRAL STENOSIS
Keywords:Acute rheumatic fever, Juvenile mitral stenosis, PTMC, Percutaneous trans mitral commissorotomy, Rheumatic heart disease
Objectives: Immediate result of PTMC in juvenile (5-12 years) rheumatic mitral stenosis.
Study Design: Observational descriptive and retrospective study.
Place and Duration of Study: Institute of Cardiology, Multan from 2009 to Jun 2020.
Methodology: This is an observational descriptive and retrospective study carried out at Institute of Cardiology, Multan from 2009 to Jun 2020. Patients with clinical evidence of significant mitral stenosis were undergone transthoracic echocardiography. Mitral stenosis was defined as mitral valve area <1.0 cm2 . Mean mitral valve gradient was calculated by mitral valve inflow velocities. Patients with Wilkins score <8 were included. Patients with significant MR, left atrial or atrial appendage clot, infective endocarditis, significant aortic regurgitation or any other indication for bypass surgery were excluded. Patients with Wilkins score >8 were also excluded from the study. Variables recorded on a performa were age, weight, left atrial size, mean mitral valve gradient, preprocedure MR. Reduction of mitral valve mean pressure gradients to less than <50% of the initial value was defined as success (without significant or moderate MR). After the procedure, variables recorded on performa were mean left atrial pressures in mmHg (on angio), mean mitral valve gradients and degree of MR (mild, mild to moderate, moderate or severe MR) on transthoracic echocardiography. Paired t-test of significance (p<0.05) was evaluated using SPSS (version 20).
Results: Forty three juvenile patients were included the in the study (2009 to June 2019). Mean age was 10.8 ± 1.4 (range 7-12) years. Mean weight was 28.9 ± 5.2 (20-37) kg. Mean mitral valve gradient (on TTE) before the procedure was 20 ± 6 mmHg. Mean left atrial size and mean area of mitral valve were 42 ± 5 mm and 0.8 ± 0.2 cm2 respectively. Balloon sizes used were 26 mm (n=19) and 24 mm (n=24). After PTMC, mean mitral valve reduced to 7 ± 2 mmHg (p<0.005) and left atrial pressure to 18 ± 7 mmHg. Post procedure transthoracic echocardiography showed 4.7% (n=2/43) patients developed moderate to severe or severe MR. So the success rate was 95.3% (n=41/43).
Conclusion: PTMC is safe and effective procedure for juvenile patients with mitral stenosis. Long term follow-up is needed to find out period of re-intervention/surgery free duration from the time of PTMC.