Increase In Mitral Valve Area Research Articles

Findings from transoesophageal echocardiographic follow-up after mitral transcatheter edge-to-edge repair.

Transoesophageal echocardiography (TOE) provides accurate evaluation of mitral valve (MV) function following mitral transcatheter edge-to-edge repair (M-TEER) and may better detect complications in case of suboptimal result. We aimed to evaluate midterm anatomical changes and structural complications after M-TEER using TOE and investigate their association with clinical outcomes at 2 years. A follow-up TOE at 6 months was systematically recommended to all patients included in our institutional prospective M-TEER registry until December 2021. We assessed changes in the incidence of mitral regurgitation (MR), MV stenosis (≥5 mmHg), and partial or complete single leaflet device attachment (SLDA) between the index procedure and follow-up and evaluated MV area and annular dimensions in a subset of patients with available three-dimensional (3D) datasets. The clinical endpoint was a composite of mortality and heart failure (HF) rehospitalisation at 2 years. Among the 373 patients included in the registry between February 2012 and December 2021, 128 patients (34%) underwent elective TOE at 6 months. Using TOE, severe MR was observed in 13.3% (n=17) of the patients. The number of patients with an elevated MV gradient increased from 17 (13.3%) after the procedure to 23 (18%) at 6 months, and a new partial or complete SLDA was detected in 7.8% (n=10). Based on 3D TOE measurements, significant increases in MV area, annular area, annular perimeter, and intercommissural (but not anteroposterior) diameter were observed compared to intraprocedural images. A mean MV gradient ≥5 mmHg (hazard ratio [HR] 2.30, 95% confidence interval [CI]: 1.10-4.81; p=0.023) and the presence of severe MR at 6 months (HR 3.26, 95% CI: 1.18-8.99; p=0.023) were associated with the primary endpoint, which was met in 34 (26.6%) patients at 2 years. TOE follow-up allowed the detection of complications that would not be diagnosed using transthoracic echocardiography only and should therefore be used liberally in the patients presenting with a suboptimal result. A mean MV gradient ≥5 mmHg and severe MR, diagnosed at the 6-month TOE follow-up, were associated with adverse clinical outcomes.

Immediate and short-term outcomes of percutaneous balloon mitral commissurotomy for severe mitral stenosis at a Resource Limited Setting, Addis Ababa, Ethiopia

BackgroundRheumatic heart disease is a common cause of mitral stenosis (MS) in developing nations. Percutaneous mitral balloon commissurotomy (PMBC) is the treatment of choice for patients with MS with favorable anatomy. ObjectiveThis study aimed to assess immediate and short-term outcomes of percutaneous balloon mitral commissurotomy for symptomatic patients with rheumatic severe mitral stenosis. MethodsThe clinical records of patients who underwent Percutaneous Mitral Balloon Commissurotomy (PBMC) at Saint Paul Hospital Millennium Medical College, Cardiac Center were reviewed. A retrospective observational study was conducted from February 01, 2018, to August 30, 2021. All eligible patients who underwent Percutaneous Mitral Balloon Commissurotomy during the study period at the cardiac center were included in this study. Ninety-one patients were enrolled in the study after excluding repeat procedures, those with incomplete data, and lost medical records. Data were collected through chart reviews using a structured questionnaire by trained physicians, with daily supervision by the investigators. Data analysis was performed using SPSS version 25. Associations were checked using a paired t-test and Fisher's Exact Test, with statistical significance set at a p-value of <0.05. ResultPercutaneous mitral balloon commissurotomy was successful in 91.2 % of patients. Following the procedure, there was a significant increase in the mean mitral valve area from 0.799 cm2 to 1.674 cm2 and a reduction in the trans-mitral mean pressure gradient from 20 mmHg to 7.71 mmHg (P < 0.001). Atrial fibrillation and a high Wilkins score were identified as correlates of non-successful PMBC. A Wilkin's score of ≤8 and a post-procedure mitral valve area > 1.5 cm2 were associated with New York Heart Association functional class improvement three months after the procedure. ConclusionIn this study, percutaneous mitral balloon Commissurotomy (PMBC) demonstrated an excellent success rate. The majority of patients exhibited significant improvement in the New York Heart Association (NYHA) functional class.

Percutaneous Transmitral Commissurotomy - Clinical and Echocardiographic Follow-up in Severe Mitral Stenosis

Objectives: To study the long term clinical and echocardiographic outcomes of percutaneous Trans mitral balloon commissurotomy (PTMC) performed in patients with severe mitral stenosis. Methodology: Total 103 patients were enrolled in this study. Their PTMC procedure was performed between the years 2015 to 2019. Those patients who returned for follow-up in the year 2021 were enrolled. At the time of follow-up their clinical and echocardiographic parameters were recorded. Results: The mean age was 27.44±6.26 years and 97 (94.2%) of them were female. Mitral valve area was improved significantly, planimetry; 0.813±1.39 vs. 1.288±0.21cm2 and PHT; 0.871±0.13 vs. 1.336±0.19 cm2 between baseline and follow-up, respectively. Pressure gradient across mitral valve also improved 7.233±2.81 vs. 14.407±0.92 mmHg between baseline and follow-up, respectively. Pulmonary artery pressures were also reduced significantly 24±0.27 vs. 55±2.41 mmHg as well as the right ventricular systolic pressures 24.4±2.94 vs. 62.34±10.98 mmHg between baseline and follow-up, respectively. At follow-up, 70.9% had NYHA I class, 16.5% had NYHA II class, 11.7% had NYHA III class, and 1% had NYHA IV class compared to 6.8%, 5.8%, 33.9%, and 53.4% pre-procedure, respectively. Conclusion: Long term follow-up of patients after PTMC showed satisfactory outcomes both clinically, as evident from improvement in NYHA functional class, and from echocardiographic stand point with sustained increase in mitral valve area over the period of years. Overall the results of PTMC performed in patients with severe mitral stenosis are satisfactory.

Outcome of Percutaneous Transvenous Mitral Commisurotomy According to Age, Gender and Heart Rhythm

Background: Percutaneous transvenous mitral commisurotomy (PTMC) is the recommended treatment in the severe mitral stenosis with mitral valve area ≤ 1.5 sq. cm and favourable mitral valve morphology without Left atrium (LA) clot.&#x0D; Methods: A retrospective study done for one year among all the patients who had undergone PTMC in 2016. Successful PTMC was defined as increase in Mitral valve area (MVA) more than or equal to 1.5 sq. cm or increase in area by more than 50% from baseline. Data was analyze using SPSS-20.&#x0D; Results: Three hundred thirty sex patients with mean age 34.08 ±12.0 of which male were 97 ( 26.9 %.) and female were 239 (71.1 %). There were 225 (67%) sinus rhythm (SR) and 111 (33%) atrial fibrillation (AF). The median Pre PTMC area and Left atrial (LA) Pressure were 0.9 sq cm and 24 mmHg respectively. The overall success of PTMC was in 289 (86%). The successful outcome in age categories less than 20 years, 20-40, 40-60 and more than 60 years in order are 39 (83%), 174 (86.6%), 71 (86.6%) and 5 (83.3 %). Success for male was 84 (86.6%) and in female 205(86%). Success percentage in SR was 192 (86%) and in atrial fibrillation was 97 (87.4%).&#x0D; Conclusion: The outcome of PTMC in terms of change in mitral valve area was similar to the different age categories, gender and presence and absence of atrial fibrillation.

Abstract 14331: Impact of Three-Dimensional Mitral Valve Geometry on Hemodynamic Severity in Rheumatic Mitral Stenosis

Introduction: Pathologic derangements of rheumatic mitral stenosis (MS) change valve shape which may determine the hemodynamic severity of the obstruction. This study was designed to assess the role of mitral valve shape on transvalvar pressure gradients in patients with MS. Methods: A total of 186 patients with MS, area of 1.1 ± 0.3 cm 2 , who underwent three-dimensional (3D) transesophageal echocardiographic study, were enrolled. A set of morphological variables to assess the mitral valve (MV) geometry, including diameter, area, height, volume and aortic-mitral angle was obtained using dedicated software. 3D doming index, the proposed index to differentiate between conical and dome shapes, was calculated by dividing the valvar volume (tenting volume) by the valvar height (tenting height). The resulting "average area" was divided by the minimum area of ​​the 3D annulus (Figure 1). Determinants of mean pressure gradient were assessed using linear regression models. Results: The 3D doming index was significantly correlated with transmitral gradient in the multivariate model (p = 0.007), adjusted for age, sex, heart rate, pulmonary artery systolic pressure, net atrioventricular compliance (C n ), and left atrial volume. Specifically, the inclusion of 3D doming index in a model with other factors that influence gradients resulted in improvement in model performance evaluated by R 2 which increased from 0.57 to 0.60. In the 152 patients who underwent successful percutaneous valvuloplasty, there was a significant correlation between the percentage of increase in the valve area and 3D doming index (r = 0.2; p &lt;0.026), after adjustment for the echo score revisited. Conclusions: In rheumatic MV stenosis, 3D geometric shape was associated with transmitral pressure gradient, independent of other parameters. 3D Doming index correlated with the percentage increase in MV area in a subgroup undergoing valvuloplasty.

Balloon Mitral Valvotomy With the Accura Double-Lumen Balloon Catheter: Immediate and One-Year Clinical Outcomes.

ObjectiveDespite the decline in the incidence of rheumatic heart disease in developed countries, the disease still remains endemic among individuals of low socioeconomic status. The aim of the study is to assess immediate and one-year outcomes of balloon mitral valvotomy using the double-lumen Accura balloon (Vascular Innovations Co., Nonthaburi, Thailand) in patients with mitral valve stenosis.MethodsThis was a single-centre, observational, investigator-initiated retrospective study. All consecutive patients undergoing balloon mitral valvotomy with the Accura balloon between January 2015 and June 2020 were included. The primary endpoint was procedural success defined as an increase in mitral valve area (MVA) ≥50% from basal valve area or final valve area of ≥1.5 cm2, in the absence of mitral regurgitation grade >2. Clinical, echocardiographic, and haemodynamic parameters were assessed at the one-year follow-up.ResultsA total of 62 patients underwent balloon mitral valvotomy. The mean age was 34.9 ± 8.0 years, and 54 (87.1%) patients were female. Mean Wilkins' echo score was 7.5 ± 0.5. Procedural success was achieved in 59 (96.7%) patients. Mean MVA increased from 0.75 ± 0.14 cm2 to 1.64 ± 0.21 cm2, and mean mitral valve gradient decreased from 24.9 ± 5.5 mmHg to 7.30 ± 1.40 mmHg. Atrial fibrillation, mitral valve replacement, and moderate to severe mitral regurgitation occurred in 36 (59.0%), two (3.3%), and two (3.3%) patients, respectively. No death, cerebrovascular accidents, restenosis, or redo procedures occurred.ConclusionBalloon mitral valvotomy using the double-lumen Accura balloon is safe in patients with mitral valve stenosis.

Immediate maternal and fetal outcome following percutaneous mitral valve balloon commissurotomy: a 6-year single-center experience from sub-Saharan Africa.

Mitral stenosis is the most common valvular heart disease during pregnancy. When severe, it leads to significant maternal and fetal morbidity and mortality. Percutaneous mitral valve balloon commissurotomy can be performed during pregnancy, and the present study aimed to describe the immediate maternal and fetal outcomes after percutaneous mitral valve balloon commissurotomy was done in a cohort of 23 pregnant patients with severe mitral stenosis in Addis Ababa, Ethiopia. Included in the current study were all pregnant mothers who had severe rheumatic mitral valve stenosis and who underwent percutaneous mitral valve balloon commissurotomy at the Cardiac Center of Ethiopia over 6-year period. Data were collected through chart abstraction using a structured proforma and then analysed using STATA version 13.0. Median gestational age was 22 weeks and percutaneous mitral valve balloon commissurotomy was successful resulting in a significant increase in the mean mitral valve area of the group from 0.78 ± 0.20 cm2 to 1.89 ± 0.31 cm2 (p < 0.001). The mean mitral valve inflow gradient of the group was 23.95 ± 6.27 mmHg and 6.80 ± 2.44 mmHg, respectively, before and after the percutaneous mitral valve balloon commissurotomy procedure (p < 0.001). Post-procedure, there was no significant increment in mitral valve incompetence. The mean pulmonary artery pressure of the group decreased from 77.68 ± 23.19 mmHg to 42.31 ± 9.95 mmHg (p < 0.001). There was no fetal or maternal death following the procedure. Pregnancy ended at term gestation for 19/23 (82.6%) of the mothers and the mean birth weight of the neonates was 2800 g. Percutaneous mitral valve balloon commissurotomy procedure can safely be done for severe symptomatic rheumatic mitral stenosis in pregnancy in our setting.

HAIR PIN LOOP TECHNIQUE WITH THREE DIMENTIONAL SHAPE SUPPORTED STYLET FOR SUCCESSFUL BALLOON MITRAL VALVOTOMY IN A DIFFICULT CASE.

Percutaneous balloon mitral valvotomy using Accura or Inoue balloon is an effective treatment for patients with rheumatic mitral stenosis suitable for valvotomy . Procedural success rates are high in experience hand with success rates are more than 90 %. Inability to cross the mitral valve is one of the prime reasons for procedure failure . We are reporting a case of 35 year female with severe mitral stenosis with severe subvalvular thickness using hairpin loop with double curve support of stylet, where all traditional methods of crossing mitral valve get failed. Mitral valvotomy successfully performed with mitral valve area increase from 0.5 cm2 to 2.1 cm 2.

Percutaneous Transseptal Bioprosthetic Implantation in Failed Prosthetic Surgical Mitral Valve - Brazilian Multicenter Experience.

ResumoFundamento A intervenção percutânea em pacientes com disfunção de prótese biológica mitral apresenta-se como uma alternativa ao tratamento cirúrgico convencional.Objetivo Relatar a primeira experiência brasileira de implante transcateter de bioprótese valve-in-valve mitral via transeptal (TMVIV-via transeptal).Métodos Foram incluídos pacientes portadores de disfunção de bioprótese cirúrgica submetidos ao TMVIV-transeptal em 12 hospitais brasileiros. Foram considerados estatisticamente significativos valores de p<0,05.Resultados Entre junho/2016 e fevereiro/2019, 17 pacientes foram submetidos ao TMVIV-via transeptal. A mediana de idade foi 77 anos (IIQ,70-82), a mediana do escore STS-PROM foi 8,7% (IIQ,7,2-17,8). Todos os pacientes tinham sintomas limitantes de insuficiência cardíaca (CF≥III), tendo 5 (29,4%) sido submetidos a mais de uma toracotomia prévia. Obteve-se sucesso do TMVIV-via transeptal em todos os pacientes. A avaliação ecocardiográfica demonstrou redução significativa do gradiente médio (pré-intervenção, 12±3,8 mmHg; pós-intervenção, 5,3±2,6 mmHg; p<0,001), assim como aumento da área valvar mitral (pré-intervenção, 1,06±0,59 cm2; pós-intervenção, 2,18±0,36 cm2; p<0,001) sustentados em 30 dias. Houve redução significativa e imediata da pressão sistólica de artéria pulmonar, com redução adicional em 30 dias (pré-intervenção, 68,9±16,4 mmHg; pós-intervenção, 57,7±16,5 mmHg; 30 dias,50,9±18,7 mmHg; p<0,001). Durante o seguimento, com mediana de 162 dias (IIQ, 102-411), observou-se marcada melhora clínica (CF≤II) em 87,5%. Um paciente (5,9%) apresentou obstrução de via de saída de ventrículo esquerdo (VSVE), evoluindo para óbito logo após o procedimento, e outro morreu aos 161 dias de seguimento.Conclusão A primeira experiência brasileira de TMVIV-transeptal demonstra a segurança e a efetividade dessa nova técnica. A obstrução da VSVE é uma complicação potencialmente fatal, reforçando a importância da seleção dos pacientes e do planejamento do procedimento. (Arq Bras Cardiol. 2020; 115(3):515-524)

Platelet distribution width can be a useful marker of decreased platelet activity after percutaneous mitral balloon valvuloplasty

Aim: Increased platelet activity and elevated mean platelet volume (MPV) has been demonstrated in patients with rheumatic mitral stenosis (RMS). However, platelet distribution width (PDW) and the impact of percutaneous mitral balloon valvuloplasty (PMBV) on PDW has never been studied. Therefore, we aimed to investigate whether PMBV decreases PDW in patients with RMS.Material and Methods: Symptomatic patients with severe RMS undergoing PMBV were included. Echocardiographic characteristics and hematologic parameters was measured just before and 1 month after the PMBV procedure.Results: A total of 30 patients (24 female, mean age: 49.8±13.2 years) were included the study. Mean transmitral pressure gradient, pulmonary artery pressures and left atrium diameter decreased but mitral valve area increased significantly after PMBV. PMBV procedure significantly decreased PDW in patients with RMS (13.5±2.3 vs 12.4±1.9 fL, before and after procedure, respectively; p&amp;lt;0.0001). MPV was decreased after PMBV but it was not statistically significant (10.9±0.8 vs 10.6±0.9 fL, p=0.056). Platelet count was significantly increased after procedure (250±62.6 vs 273.5±78.6 x103/ul, p=0.035). In linear regression analysis, an independent relationship was found in magnitude of PDW decrease and magnitude of increase in mitral valve area (ẞ:0.491, p=0.046). Conclusion: PMBV is associated with a significant decrease in PDW 1 month after the procedure. There was a significant correlation between the magnitude of decrease in PDW and magnitude of increase in mitral valve area after PMBV.

Effect of Mitral Valve Leaflets Excursion on Mitral Valve area after Percutaneous Trans- Venous Mitral Commissurotomy

Background: Aim of our study was to predict the effect of mitral valve leaflets excursion on mitral valve area following percutaneous transvenous mitral commissurotomy PTMC in patients of mitral stenosis.Methods: Total 70 patients with severe mitral stenosis who underwent PTMC were enrolled in the study.Transthoracic echocardiography was done the day before PTMC and 24-48 hours after PTMC. Mitral valve area, anterior and posterior leaflets excursion were recorded. The relation between leaftlet excursion and mitral valve after PTMC was evaluated.Results: Following PTMC there were significant increasein anterior leaflet excursion from 1.9 ± 0.2 to 2.3 ± 0.2cm (p&lt;0.001), posterior leaflet excursion from 1.6±0.2to1.9 ± 0.2cm (p&lt;0.001). Mitral valve areas increased from 0.8 ± 0.1 to1.7 ± 0.2cm²(p&lt;0.001). Both leaflet excursion increased significantly with the increase in mitral valve area till the area reached a value of about 1.5 cm2, after which any further increase in mitral valve area was not associated with any further increase in leaflet excursion.Conclusion: PTMC is associated with immediate significant changes in mitral valve morphology in terms of splitting of fused mitral commissures, increased leaflets excursion and splitting of the subvalvular structures. Post PTMC leaflet excursion increases significantly with the increase in mitral valve area till the area reaches a value of about 1.5 cm2 after which any further increase in mitral valve area is not associated with any further increase in leaflet excursion.Cardiovasc. j. 2017; 10(1): 3-7

SEVERE MITRAL STENOSIS;

Objectives: To evaluate the immediate outcomes of PTMC in patients with severemitral valve stenosis. Study Design: Cross-sectional study. Setting: Ninety (90) subjects whounderwent PTMC in Cardiac Catheterization Department of CPE Institute of Cardiology. Period:June 2008 to June 2011. Methods: Patients with severe MS having mitral valve (MV) area &lt;1.0cm2 and having morphology suitable for PTMC in the absence of regurgitation and left atrial clotwere included in this study. An increase in mitral valve area more than 50% of the baseline areawithout the development of moderate to severe MR was considered as the procedural success.Data were analyzed using SPSS V19. Pre and post procedural outcomes were measured usingpaired sample t-test. Results: There were a total number of ninety (90) patients in this study.Mean age of subjects was 28.08+9.61 years. There were more females 59 (65.5%) as comparedto only 31 (34.5%) males. There was significant increase in mitral valve area, 1.83+0.36 cm2post-PTMC versus 0.63+0.17 cm2 pre-PTMC (p-value &lt;0.001). There was significant decreasein Peak pressure gradient (PPG) from 28.31+6.01 mmHg to 12.85+3.20 mmHg after PTMC(p-value &lt;0.001). There were also significant reductions in mean pressure gradient andpulmonary artery systolic pressures after PTMC with p-value &lt;0.001 and &lt;0.001 respectively.PTMC was successful in 87 (97.7%) patients and it failed in only 3 (3.3%) patients. Conclusion:PTMC is an excellent treatment option regarding optimal outcomes and success rate in patientsof severe mitral stenosis especially when performed by experienced interventionists.

English

Objectives: To evaluate the immediate outcomes of PTMC in patients with severemitral valve stenosis. Study Design: Cross-sectional study. Setting: Ninety (90) subjects whounderwent PTMC in Cardiac Catheterization Department of CPE Institute of Cardiology. Period:June 2008 to June 2011. Methods: Patients with severe MS having mitral valve (MV) area &lt;1.0cm2 and having morphology suitable for PTMC in the absence of regurgitation and left atrial clotwere included in this study. An increase in mitral valve area more than 50% of the baseline areawithout the development of moderate to severe MR was considered as the procedural success.Data were analyzed using SPSS V19. Pre and post procedural outcomes were measured usingpaired sample t-test. Results: There were a total number of ninety (90) patients in this study.Mean age of subjects was 28.08+9.61 years. There were more females 59 (65.5%) as comparedto only 31 (34.5%) males. There was significant increase in mitral valve area, 1.83+0.36 cm2post-PTMC versus 0.63+0.17 cm2 pre-PTMC (p-value &lt;0.001). There was significant decreasein Peak pressure gradient (PPG) from 28.31+6.01 mmHg to 12.85+3.20 mmHg after PTMC(p-value &lt;0.001). There were also significant reductions in mean pressure gradient andpulmonary artery systolic pressures after PTMC with p-value &lt;0.001 and &lt;0.001 respectively.PTMC was successful in 87 (97.7%) patients and it failed in only 3 (3.3%) patients. Conclusion:PTMC is an excellent treatment option regarding optimal outcomes and success rate in patientsof severe mitral stenosis especially when performed by experienced interventionists.

Successful Percutaneous Mitral Valve Balloon Valvuloplasty during Third Trimester

ABSTRACT Rheumatic mitral stenosis is the most common acquired valvular lesion in pregnant women. The overall mortality is 1%, but can go up to 5% in those patients with New York Heart Association class III and IV symptoms. Percutaneous mitral balloon valvuloplasty (PMBV) is the procedure of choice in the treatment of rheumatic mitral stenosis. The PMBV is usually done in the first or second trimester, but in the third trimester, PMBV is a less common procedure. A 24-year-old gravida 2 para 1 living 1 with 35 weeks of gestation with previous lower segment cesarean section (LSCS) presented with breathlessness and swelling of lower limbs. Evaluation revealed rheumatic mitral stenosis of moderate severity with moderate mitral regurgitation with cardiac failure. Hence, PMBV was done, which resulted in increase of mitral valve area from 0.6 to 1.7 cm2. She had marked symptomatic improvement, and cesarean section was done at 36 weeks 5 days for previous LSCS with preterm premature rupture of membranes. The postoperative period was uneventful. Our report reinforces the fact that third trimester PMBV is safe and effective during pregnancy with no untoward effect on the fetus. How to cite this article Shivanagappa M, Sree GS, Roy P, Manoli N. Successful Percutaneous Mitral Valve Balloon Valvuloplasty during Third Trimester. J South Asian Feder Obst Gynae 2017;9(2):182-184.

Echocardiographic parameters for assessing successful balloon mitral valvuloplasty in juvenile age groups.

Different echocardiographic parameters have been studied and validated for assessing the severity of mitral stenosis; however, scant data are available for these markers in the context of balloon mitral valvuloplasty in juvenile age groups (ages ⩽20 years). The aim of the present study was to find out the utility of echocardiographic parameters such as mitral valve separation index, left atrial volume, right ventricular systolic pressure, tricuspid annular plane systolic excursion, tricuspid annular systolic velocity, and right ventricular Tei index in predicting success of balloon mitral valvuloplasty and their relation to mitral valve area in juvenile mitral stenosis. We carried out a prospective single-centre study involving 52 juvenile mitral stenosis patients undergoing elective valvuloplasty. Success was defined as an increase in mitral valve area ⩾50% or ⩾1.5 cm2. Echocardiographic measurements were taken before and 24 hours after the procedure and statistical analyses were carried out. The mean age of the study population was 14.3 years (SD ±4.55), ranging from 7 to 20 years. Valvuloplasty was successful in 49 out of 52 patients. The mean valve area improved from 0.89 (SD ±0.16) to 1.73 (SD ±0.22) cm2/m2 (p<0.01), and the mean mitral valve gradient decreased from 19.87 (SD ±7.89) to 7.45 (SD ±2.07) (p=0.021). All the surrogate parameters improved favourably after valvuloplasty (p<0.01). The decrease in right ventricular systolic pressure was a better indicator of the success followed by the increase in valve separation index (area under the curve 0.81 and 0.76, respectively). All the surrogate markers studied showed favourable improvement, and right ventricular systolic pressure reduction and improved mitral valve separation index were better indicators of successful valvuloplasty.

Catheter interventions for mitral stenosis in children: results and perspectives.

Stenosis of the mitral valve most often occurs as a result of chronic rheumatic heart disease, causing thickening and fibrosis of the mitral valve apparatus. Rheumatic heart disease continues to be a major public health problem in several developing countries and mitral stenosis is also common in these regions. According to the reports from India and Africa, the disease tends to follow a rapidly progressive course in children. The treatment of choice is balloon dilatation of the mitral valve. Echocardiography is indispensable for this procedure. Before planning the procedure, it is essential to assess the suitability of balloon dilatation. Echocardiography performed during the procedure helps to decide whether the size of the balloon needs to be increased in case of inadequate relief of stenosis. Most published series have reported an immediate success rate of over 90% with balloon dilatation in children and young adults. With an increase in mitral valve area and improvement in functional class, the left atrial pressure and the transmitral gradients fall. These gratifying results are also reported from very young children of less than 12 years of age. It is recommended to start with a smaller balloon size and increase its size in a stepwise fashion to minimize complications. The complications, seen in about 1% to 2% of cases, include development of significant mitral regurgitation and hemopericardium, secondary to cardiac chamber perforation. The long-term results indicate slightly higher restenosis rates in children than in adults. Most children with restenosis can undergo successful repeat dilatation.

Very early complication of rheumatic heart disease (valvuloplasty for severe mitral valve stenosis for 6 year old male patient)

Rheumatic heart disease continues to contribute greatly to the burden of cardiovascular disease in Yemen, It’s usual to see a lot of advance RHD cases in adult in Yemen but in pediatric it is rare to see such advance case specially under the age of eight. Case report A.M, a 6 year old Yemeni male child was seen in September 2012 with history of recurrent breathlessness which started about 4 years earlier. His symptoms worsened in the previous three weeks when he became breathless at rest, had paroxysmal nocturnal dyspnea, huge abdominal distention, bilateral leg swelling and cough productive of whitish sputum. Past history was not significant for recurrent sore throat but he was diagnosed to have RHD at age of 3 year old without any farther follow up and irregular using to long acting penicillin. He was the second child in his family; both parents are in a very low income group. There was no family history of the disease in any of his siblings. Examination revealed that the child looked marasmic, pale, was chronically ill, and had a tinge of jaundice with bilateral pitting pedal edema. A cardiovascular system examination revealed a pulse rate of 101 per minute, regular and small volume, blood pressure of 90/60 m mmHg, elevated jugular venous pressure, displaced apex beat which was located at 5th intercostal space anterior axillary line, loud first and second heart sounds opening snap and mid diastolic rumbling murmur with systolic murmur at left parasternal border. The respiratory rate was 26 cycles per minute and bilateral crepitations. Other examination findings were visible dilated abdominal vein, a tender, pulsatile hepatomegaly of 3 cm below the right coastal margin and massive ascites. An echocardiography showed densely thickened mitral valves with severe commissural fusion leading to doming of the mitral valve in diastole, markedly dilated left atrium, normal left ventricular eject ion fraction, markedly dilated right atrium and right ventricle. Colour flow showed severe tricuspid regurgitation and severe pulmonary hypertension. The calculated mitral valve area is 0.6 cm square and pressure gradient max/mean (14/6 mmHg) respectively. ECG sinus rhythm normal axis and dilated LA with RBBB Complete blood count showed low HB 9 mg/dl with normal a white cell count. The chest X-ray revealed cardiomegaly with a double cardiac shadow positive mitralization sign. He was placed on diuretics (furosemide and low-dose spironolactone) Angiotensin Converting Enzyme inhibitor (Lisinopril), intranasal oxygen, intravenous heparin and antibiotics. And was prepared for percutaneous mitral valvuloplasty On the third day of admission, The PMVP was done with good out come the mitral valve area increase from 0.6 to 1.8 cm 2 and decrease in the pressure gradient to 6/4 mmHg and the pulmonary hypertension to mild. After that patient condition get better with improving to the dyspnea, the child become more active start to eat and play more frequent than before with decrease to the abdominal distension and the patient discharge to home in good condition and advice to follow up the hospital after six month. Discussion Rheumatic heart disease, no doubt remains a disease with great morbidity and mortality in most low and middle income countries specially in Yemen despite been having almost eradicated in high income countries, it affects the young population of our community whom presented late most of the time with complication due to the shortage of the medical service in the most of the regain of Yemen specially the remote areas. The case being presented typifies the cost of late presentation in patients with rheumatic heart disease. its usual in our country to see such cases in late stage and complicated but it’s rare to see a 6 year old child presented with severe mitral stenosis and he needed PMVB even it is successful procedure that saved his live but all that could be prevented from happening in the first place by a simple preventive program which we do not have in our country.

Impact of Pulmonary Artery Stiffness on Right Ventricular Function and Tricuspid Regurgitation after Successful Percutaneous Balloon Mitral Valvuloplasty: The Importance of Early Intervention

We assessed impact of pulmonary artery stiffness (PAS) on the long-term right ventricular (RV) function and tricuspid regurgitation (TR) changes after percutaneous balloon mitral valvuloplasty (PBMV). Using Doppler echocardiography, PAS was calculated by dividing maximal frequency shift of pulmonary flow by the acceleration time, and mitral area, RV function, and degree of TR severity were evaluated before, immediately after, 6 months, and 12 months after successful PBMV in 81 consecutive patients. Compared with control subjects patients with mitral stenosis (MS) had significant higher PAS (P < 0.001). The PAS was significantly lower in patients with progressive RV function improvement and regression of TR (P < 0.001). PAS was significantly correlated with the degree of pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion (TAPSE), and E/E'm ratio (P < 0.0001, <0.0001, and < 0.001, respectively). Multivariate regression analysis showed that the PAS is an independent predictor of TR regression and sustained RV functional improvement after successful PBMV (P < 0.0001). The changes in RV function and TR after successful PBMV were significantly correlated with the degree of PAS. Despite a sustained increase in mitral valve area, some patients showed no regression of TR, and progressive RV dysfunction suggests a significant role of PAS on RV function and the degree of TR regression in patients with MS suggests that PBMV must be performed early, utilizing PAS as a noninvasive parameter for proper timing for PBMV.

Percutaneous Transluminal Mitral Commissurotomy for Rheumatic Mitral Stenosis in a 5-Year-Old Child

We report a 5-year-old boy weighing 11 kg, with severe mitral valve stenosis of rheumatic aetiology, who underwent successful percutaneous transluminal mitral commissurotomy (PTMC) with valvuloplasty balloon. Postprocedural mean pressure gradient across the mitral valve decreased to 6 mmHg from an initially recorded value of 22 mmHg. In addition to symptomatic improvement, the mitral valvular area increased from 0.4 to 0.8 cm(2) without significant change in mitral regurgitation. At 1- and 3-month follow up, transthoracic echocardiography revealed further improvement with an increase in mitral valve area to 1.0 cm(2), a decrease in pulmonary arterial pressure, and a mean mitral valve pressure gradient of 8 mmHg with trivial mitral regurgitation. To best of our knowledge, this is the first successful PTMC procedure performed in the youngest and smallest ever reported child with rheumatic mitral stenosis (MS). We conclude that PTMC with valvuloplasty balloon could be a logical alternative to surgery in young patients with rheumatic MS.

Copeptin Level and Copeptin Response to Percutaneous Balloon Mitral Valvuloplasty in Mitral Stenosis

We aimed to investigate copeptin levels in mitral stenosis (MS) patients and the behavior of copeptin after hemodynamic improvement achieved by percutaneous balloon mitral valvuloplasty (PBMV). The study involved 29 consecutive symptomatic patients with moderate to severe rheumatic MS who underwent PBMV. Twenty-eight age- and gender-matched healthy volunteers composed the control group. Blood samples for copeptin were obtained immediately before and 24 h after PBMV, centrifuged, then stored at -70°C until assayed. The copeptin level of the patient group was statistically different from that of the control group (61.8 ± 34.4 and 36.8 ± 15.2 pg/ml, respectively; p = 0.001). PBMV resulted in a significant increase in mitral valve area and a significant decrease in transmitral gradient as well as systolic pulmonary artery pressure. While hemodynamic relief was obtained, we detected a statistically significant decline in copeptin levels 24 h after PBMV compared to the baseline levels (from 61.8 ± 34.4 to 44.1 ± 18.2 pg/ml; p = 0.004).