Abstract
Percutaneous mitral balloon commissurotomy (PMBC) is the treatment of choice for rheumatic mitral stenosis with favorable anatomy and prevents complications inherent to a surgical procedure, while maintaining effectiveness. In view of this, we examined the immediate outcome and its predictors of patients undergoing PMBC in our Cardiac Center and availed evidence based information for future use of the treatment in Ethiopia. A retrospective data analysis of 330 patients with symptomatic severe mitral stenosis treated with PMBC using Inoue balloon in the cardiac center Ethiopia from 2014 to 2018 were assessed for their clinical outcome for those who presented for the first time in our cardiac center, Addis Ababa. Demographic, clinical, echocardiographic and hemodynamic data of all patients with symptomatic severe mitral stenosis were collected and analyzed. Of the 330 PMBC performed during the 5 years in the center, the majority had successful procedure (97.88%) and optimal result (92.42%). Twenty four (7.2%) had complications of which 7 (2.1%) had failed procedure and 9 (2.7%) marked mitral regurgitation. Atrial fibrillation was observed in 67 (20.3%). The mean mitral valve score (MVS) was 7.3± 1.35 ranged from 4 to 13. A significant association of immediate outcome was observed with atrial fibrillation (AOR=4.41; 95% CI=1.51 to 12.89) and high mitral valve total Wilkins score (AOR=0.25; 95% CI 0.09 to 0.70). The major predictors identified for poor outcome are atrial fibrillation and MVS. Percutaneous mitral balloon commissurotomy is a safe procedure with excellent immediate results signifying that it is a treatment of choice for heterogeneous group of patients with rheumatic mitral stenosis.
Highlights
Rheumatic fever (RF) has been the major culprit of rheumatic mitral stenosis (MS) and constitutes about 25 percent of all patients with rheumatic heart diseases [1,2,3]
In cases of unfavorable morphology (Wilkins score > 8) [11, 12] it postpones the need for surgical mitral valve replacement
The present study has addressed an important issue of practical importance in the management of symptomatic severe mitral stenosis in Ethiopian context and yielded an excellent result which is analogues with a number of previous studies done elsewhere that documented satisfactory immediate and long-term outcome [18,19,20,21,22]
Summary
Rheumatic fever (RF) has been the major culprit of rheumatic mitral stenosis (MS) and constitutes about 25 percent of all patients with rheumatic heart diseases [1,2,3]. MS evolves more rapidly, possibly due to severe or repeated streptococcal infections, genetic influences, or economic conditions and results in characteristic changes of the mitral valve with the diagnostic features of thickening at the leaflet edges, fusion of the commissures, and chordal shortening and fusion. Using Inoue balloon has long been considered an effective treatment modality among patients with favorable valve morphology, [6,7,8,9] and provides sustained hemodynamic improvement with minimal complication [10]. The procedure has been reported to be technically successful in over 90% of patients with its excellent long-term durability. Some of the unfavorable conditions include left atrial appendage clot and a redo-PMBC which may be associated with increased complications or incomplete success. Difficult anatomy with intertribal sepal bulge, giant left atrium, calcific valve and involvement of submitral apparatus make left ventricular entry difficult during PMBC
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