Balloon Mitral Valvotomy in Indigenous Patients With Rheumatic Heart Disease

Abstract

Background: Approximately 3% of young Indigenous Australians suffer from rheumatic heart disease (RHD) and it is also common in Asian and African migrants. Though percutaneous balloon mitral valvotomy (PBMV) is widely performed procedure throughout the world, it is sparingly done in Queensland as evidenced by the Qcor data which shows the total number of PBMV's in 2017 was only six. Results: Between 2015 to 2018, five patients were referred for a BMV procedure to The Townsville Hospital. Four patients were identified as Indigenous and one was of Philippines descent. Most of the Indigenous patients were females (75%) belonging to 34–39 years age group. All of them reside in remote areas, present to hospitals late as family and cultural factors play an important role in their health decisions. A detailed echocardiographic assessment showed severe mitral stenosis with Wilkins score of 8 or greater and moderate to severe pulmonary hypertension. All cases were performed under local anesthesia and fluoroscopic guidance except for one case which required intracardiac echocardiography. Brockenbrough needle was utilized for transeptal puncture and Inoue balloons for percutaneous mitral valvotomy. One patient was referred for surgery after two failed attempts. In successful patients, the mean transmitral resting gradients dropped from 15 mm Hg to 4 mm Hg. There were no complications during the procedures and the patients remained asymptomatic after one year of follow up. Conclusion: PBMV is a safe, cost-effective and possibly underutilized treatment option for RHD in the Indigenous population with pliable valves and minimal mitral regurgitation.