Abstract
BackgroundThe objective of the study was to determine the long-term outcomes, including mitral restenosis and regurgitation, after successful percutaneous transvenous mitral commissurotomy (PTMC).MethodsThis cross-sectional prospective study was conducted at the cardiology department of Lady Reading Hospital, Peshawar, Pakistan, from January 2007 to December 2009. A total of 84 patients were followed up for a period of 96 months. Pre and post percutaneous transvenous mitral commissurotomy echocardiography was done on the mitral valve area (MVA) using two-dimensional (2D) and color doppler echocardiography. Patients who had successful PTMC were followed up for MVA loss, mitral regurgitation (MR), and cardiac death. SPSS Software (IBM SPSS Statistics for Windows, Version 22.0, Armonk, NY: IBM Corp.; 2013) was used for data analysis.ResultsOf the 84 patients, 21 were male, and 63 were females. The mean age was 35 ± 11 years. After PTMC, the mean valve two-dimensional area increased from 0.84 ± 0.13 to 1.83 ± 0.49 cm2 (p value <0.001). MR was mild in 49 patients (62.8%), moderate in 27 patients (34.6%), and severe in two patients (2.6%). Good results were achieved in 60 (71.4%). Patients with good results were younger (24 ± 4), and had a relatively lower Wilkin's score, with a mean value of (8.4 ± 2.8). Follow-up events were death in six patients, mitral valve replacement (MVR) in 10 patients, and restenosis in seven patients. The Kaplan-Meier curve was used for the follow-up end points. Patient who required PTMC for mitral restenosis survived for a longer time than those requiring MVR, and those who had cardiac death due to severe pulmonary hypertension or heart failure.ConclusionPatients who had favorable Wilkin’s score and underwent PTMC for severe symptomatic mitral stenosis had better event-free survival in the long term follow-up.
Highlights
In the western world, the incidence of rheumatic fever is decreasing, but it is still a common problem in developing countries like Pakistan with a prevalence rate of 22/1,000 population
Pre and post percutaneous transvenous mitral commissurotomy echocardiography was done on the mitral valve area (MVA) using twodimensional (2D) and color doppler echocardiography
After percutaneous transvenous mitral commissurotomy (PTMC), the mean valve two-dimensional area increased from 0.84 ± 0.13 to 1.83 ± 0.49 cm2 (p value
Summary
The incidence of rheumatic fever is decreasing, but it is still a common problem in developing countries like Pakistan with a prevalence rate of 22/1,000 population. Certain studies have reported the incidence of rheumatic fever and rheumatic heart disease (RHD) to be as high as 206/100,000 and 18.6/1000 respectively in different geographical areas of Pakistan [1,2]. Patients with acute rheumatic fever are asymptomatic initially, until severe mitral stenosis (MS) develops and patients become symptomatic. It takes approximately 10 to 15 years to develop severe symptoms i.e. New York Heart Association (NYHA) Class IV symptoms and needs intervention. Patients with MS with favorable anatomy are treated with percutaneous approach. High Wilkin's score or moderate to severe mitral regurgitation (MR) are treated with mitral valve surgery. The objective of the study was to determine the long-term outcomes, including mitral restenosis and regurgitation, after successful percutaneous transvenous mitral commissurotomy (PTMC)
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