Abstract
AimsPTMC produces significant changes in mitral valve morphology as improvement in leaflets mobility. The determinants of such improvement have not been assessed before.Methods and resultsThe study included 291 symptomatic patients with mitral stenosis undergoing PTMC. Post-PTMC subvalvular splitting area was a determinant of post-PTMC excursion in both the anterior (B 0.16, 95% CI 0.03 to 0.30, p < 0.05) and the posterior (B 0.12, 95% CI 0.01 to 0.24, p < 0.05) leaflets. Another determinant was the post-PTMC transmitral pressure gradient for anterior (B -0.02, 95% CI -0.04 to -0.005, p < 0.01) and posterior (B -0.01, 95% CI -0.04 to -0.005, p < 0.05) leaflets excursion. The relationship between post-PTMC MVA and leaflet excursion was non-linear "S curve". There was a steep increase of both anterior (p, 0.02) and posterior (p, 0.03) leaflets excursion with increased MVA till the MVA reached a value of about 1.5 cm2; after which both linear and S curves became nearly parallel.ConclusionThe improvement in leaflets excursion after PTMC is determined by several morphologic and hemodynamic changes produced in the valve. The increase in MVA improves mobility within limit; after which any further increase in MVA is not associated by a significant improvement in mobility in both leaflets.
Highlights
Percutaneous transvenous mitral commissurotomy (PTMC) was found to be associated with splitting of the fused mitral commissures with a subsequent increase in the mitral valve area (MVA) [1,2,3,4,5,6,7]
PTMC was found to produce a significant increase in the MVA, splitting of the fused anterior and posterior commissures, and improvement in leaflet mobility; reflected as increased excursion of both leaflets
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
Summary
Percutaneous transvenous mitral commissurotomy (PTMC) was found to be associated with splitting of the fused mitral commissures with a subsequent increase in the mitral valve area (MVA) [1,2,3,4,5,6,7]. Not all patients with commissural splitting after the procedure were found to have an optimal MVA [6]. This suggested that the mechanism of successful PTMC may be more complex than was reported previously. Short term improvements in MVA and symptoms that occur when commissures are not split may be attributed to other mechanisms, such as improvement of leaflet mobility secondary to disruption of the diseased submitral tissue [7]. Assessment of the other changes produced in mitral valve morphology may have an adjuvant value to the conventional measurement of the MVA in the morphologic assessment of the mitral (page number not for citation purposes)
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