Percutaneous Mitral Commissurotomy Research Articles

OR13-7 | Intracardiac Echocardiography Guided Percutaneous Mitral Balloon Commissurotomy Case Series: A New Approach to an old Procedure

OR13-7 | Intracardiac Echocardiography Guided Percutaneous Mitral Balloon Commissurotomy Case Series: A New Approach to an old Procedure

20-year follow-up of rheumatic mitral stenosis patients after percutaneous mitral commissurotomy: invasive transmitral gradient differential as a predictor of events.

Percutaneous mitral valve commissurotomy (PMC) is a viable alternative to mitral valve (MV) surgery in the treatment of patients with rheumatic mitral stenosis (RMS). In this single-center retrospective study of consecutive patients with RMS submitted to PMC from 1991 to 2008, we analyzed clinical, echocardiographic, and hemodynamic data and events during follow-up (FUP) until December 2021. Major adverse cardiovascular events (MACE) were a combined endpoint of all-cause death, cardiovascular hospitalization, and MV re-intervention. A total of 124 patients were enrolled: 108 (87.1%) were female, with a mean age at PMC of 46 [standard deviation (SD) 11] years. PMC was successful in 91.1%, with a mean reduction in invasive transmitral pressure gradient (TMPG) of 8 (SD 7) mmHg at PMC time. During the mean FUP of 20 (SD 6) years, 51 (41.1%) patients had MV re-intervention (86.3% surgery and 13.7% redo-PMC), 37 (29.8%) were hospitalized, and 30 (24.2%) died. Approximately 75% of patients remained MACE-free after 10 years, and this percentage decreased to around 40% after 20 years; at this time mark, about 8 in 10 patients were alive. A reduction of <5 mmHg in TMPG at PMC time was associated with a 2.7-fold greater rate of MACE compared to a reduction of ≥5 mmHg, independent of MV regurgitation after PMC and moderate disease of other valves (adjusted hazard ratio 2,7; 95% confidence interval 1.395-5.298, p=0.003). In this cohort with favorable long-term results after PMC, a reduction of <5 mmHg in TMPG at PMC time was associated with MACE during FUP. More studies are needed to validate this independent predictor.

Assessment of Suitability for Percutaneous Mitral Commissurotomy: A Contemporary Review of Key Anatomical Criteria and Predictive Models.

The immediate result of percutaneous balloon mitral commissurotomy (PMC) is largely determined by the anatomy of the mitral valve complex. Several scores and models have been developed to assess anatomical suitability for PMC. Although none has an optimal predictive power, these models look at the valvular apparatus from different perspectives bearing the potential for a complementary role.

Systolic Pulmonary Artery Pressure Thresholds Predictive of Dyspnea on Stress Doppler Echocardiography in Mitral Stenosis.

On Stress Doppler Echocardiography (SDE) in mitral stenosis, the systolic pulmonary artery pressure (SPAP) threshold at peak exercise recommended by the guidelines as an indication for percutaneous mitral commissurotomy (PMC) used to be 60 mmHg. However, because of the paucity of studies, that threshold has been controversial. The Europeans stopped using the value in 2007, followed by the Americans in 2014. Determine SPAP thresholds on SDE at peak exercise and post-exercise predictive of dyspnea as an indication for PMC in mitral stenosis. Three hundred mitral stenosis patients with a mitral valve area (MVA) ≤ 2 cm2 and NYHA I-II-III were included. A treadmill stress test (Bruce protocol) was used in all cases to distinguish dyspneic patients (n = 182) from non dyspneic patients (n = 118). SDE was performed on a stress echocardiography bed, starting at 30 W and increasing by 30 W every 3 min. At peak exercise, the best SPAP threshold obtained was 75 mmHg: specificity (Sp) = 0.98 (0.94-1), positive likelihood ratio (LR+) = 47 (41-50), positive predictive value (PPV) = 0.99 (0.95-1), and positive predictive error (PPE) = 0.01 (0.002-0.05). This compared with, respectively, 0.34, 1, 0.69 and 0.31 at 60 mmHg. Post-exercise, the best SPAP threshold found was 60 mmHg: Sp = .94 (0.88-0.97), LR = 9 (4-10), PPV = 0.94 (0.87-0.97), and PPE = 0.06 (0.03-0.13). Regarding the prediction of dyspnea as an indication for PMC, our study shows that a SPAP value at peak exercise of 60 mmHg lacks predictive power (LR+=1). The optimal threshold observed was 75 mmHg at peak exercise (LR+ = 47 [41-50]) and 60 mmHg post-exercise (LR+ = 9 [4-10]).

Crossing the Barriers of Left Ventricular Entry during Percutaneous Transluminal Mitral Commissurotomy by Agilis nxT Catheter

Balloon mitral valvotomy is an effective procedure for the management of mitral stenosis. Procedural failures were reported due to difficulty in the left ventricle (LV) entry, which were addressed by veno-arterial or reverse looping of the balloon catheter. We are reporting three cases in whom LV entry was succeeded with an Agilis NxT catheter.

Penicillin therapy effect on MMP-2 and TIMP-2 levels in mitral restenosis after percutaneous mitral commissurotomy

Penicillin therapy effect on MMP-2 and TIMP-2 levels in mitral restenosis after percutaneous mitral commissurotomy

Management of mitral stenosis during pregnancy interest of percutaneous mitral commissurotomy: About 246 cases

Management of mitral stenosis during pregnancy interest of percutaneous mitral commissurotomy: About 246 cases

Surgical rescue mitral valve procedure post percutaneous transluminal mitral commissurotomy-a single-center observational study.

Percutaneous transluminal mitral commissurotomy (PTMC) has become the standard of care for severe mitral stenosis with favorable anatomy. Although the complications have reduced over the years, the need for emergency surgical rescue persists. This study evaluates the outcomes of surgical rescue performed within 24h of undergoing PTMC from 1 January 2013 to 31 December 2019. Out of 2259 PTMC patients, 22 patients (< 1%) required rescue mitral valve surgery. Out of 22 patients, 17 patients (77.27%) developed mitral regurgitation; five patients (22.7%) had cardiac tamponade. Mitral valve replacement was performed in 20 patients (90.9%), while two patients (9.1%) underwent mitral valve repair. Cardiac tamponade was secondary to injury of the left atrium (9.1%), left ventricle (4.5%), and right ventricle (9.1%). Concomitant tricuspid valve repair was done in three patients (13.6%). Intraoperatively, anterior mitral leaflet tear was seen in 68.2% while posterior mitral leaflet tear was noted in 9.1%. Postoperatively, three patients (13.6%) required prolonged ventilation, incidence of stroke was 4.5% (n = 1), and in-hospital mortality was 4.5% (n = 1). Intra-aortic balloon pump was used in three patients (13.6%), preoperatively. We conclude that post-PTMC complications are rare, but they require urgent surgical intervention.

Evaluation of right ventricular strain and strain rate in patients with severe mitral stenosis before and after one month of Percutaneous Transluminal Mitral Commissurotomy (PTMC)

Evaluation of right ventricular strain and strain rate in patients with severe mitral stenosis before and after one month of Percutaneous Transluminal Mitral Commissurotomy (PTMC)

Artificial Intelligence Enhances Heart Surgeries

BACKGROUND: Heart surgery is used to treat serious heart diseases. METHODS: This is a perspective article on heart surgeries, by reviewing the papers on Europe percutaneous mitral commissurotomy (PMC) concerning heart surgeries, as Europe PMC is a trusted academic engine. The author included all papers on the subject, but papers from the last 5 years are the favorite for references, without exclusion from review. RESULTS: There are 192,265 case reports (28.5%), 143,267 clinical trials (21.2%), 303,690 reviews (45%), and 34,323 miscellaneous (5%). CONCLUSIONS: Artificial intelligence is the future of advances in heart surgeries as they are highly distributed in the world.

TCT-493 Maternal and Fetal Outcomes Following Percutaneous Transluminal Mitral Commissurotomy in 70 Pregnant Women With Critical Mitral Stenosis: An Experience of a Tertiary Care Center

TCT-493 Maternal and Fetal Outcomes Following Percutaneous Transluminal Mitral Commissurotomy in 70 Pregnant Women With Critical Mitral Stenosis: An Experience of a Tertiary Care Center

TCT-149 Severe Pulmonary Artery Hypertension and Rheumatic Disease: Long-Term Follow-Up After Percutaneous Mitral Balloon Commissurotomy

TCT-149 Severe Pulmonary Artery Hypertension and Rheumatic Disease: Long-Term Follow-Up After Percutaneous Mitral Balloon Commissurotomy

TCT-148 Percutaneous Mitral Balloon Commissurotomy and Restenosis Due to Rheumatic Disease: Single-Center Experience

TCT-148 Percutaneous Mitral Balloon Commissurotomy and Restenosis Due to Rheumatic Disease: Single-Center Experience

Inoue percutaneous mitral commissurotomy in rheumatic mitral stenosis with variable echocardiographic scores

Inoue percutaneous mitral commissurotomy in rheumatic mitral stenosis with variable echocardiographic scores

Short Term Effect of Percutaneous Mitral Commissurotomy on P Wave Dispersion in Patients with Mitral Stenosis

Short Term Effect of Percutaneous Mitral Commissurotomy on P Wave Dispersion in Patients with Mitral Stenosis

Evaluation of Pregnancy Outcome in Women with Rheumatic Mitral Valve Stenosis

Background and Aims: Rheumatic heart disease is still one of the most common heart lesion in developing countries. The maternal and fetal hazards increase with the severity of Mitral stenosis. This study was aimed to determine the fetomaternal outcome in women with mitral stenosis during pregnancy. Methods: This was descriptive cross-sectional study which included all pregnant patients with isolated rheumatic mitral valve stenosis. Major adverse outcomes studied were cardiac failure, thromboembolic event, admission in cardiac care or intensive care unit, atrial fibrillation, endocarditis, pulmonary hypertension and cardiac death. Results: Out of 3194 pregnant women, 31 had mitral stenosis. Their mean age was 27 years, mean mitral valve area 1.43cm2 and majority were primigravida (61.29%). Among them, symptomatic cardiac failure was present in 6.66%, 30% and 66.66% of mild, moderate and severe mitral stenosis respectively. The chances of cardiac failure, atrial fibrillation, preterm delivery and small for gestational age babies was high in all patients without having percutaneous trans-luminal mitral commissurotomy than those who underwent the procedure for moderate to severe mitral stenosis during pregnancy. Conclusion: There were high chances of adverse fetomaternal outcome in pregnant women with mitral stenosis. Cardiac failure was found to be increased with the severity of mitral stenosis. PTMC during pregnancy resulted in decreased cardiac failure, atrial fibrillation, preterm delivery and small for gestational age babies.

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.

Reduction in pulmonary artery pressures on right heart cath after percutaneous transmitral commissurotomy.

Objectives: To find out the reduction in pulmonary artery pressures on right heart Cath after percutaneous trans mitral commissurotomy. Study Design: Cross-sectional Observational study. Setting: Catheterization Lab Faisalabad Institute of Cardiology, Faisalabad. Period: April 2022 till October 2022. Material &amp; Methods: After approval from hospital ethical committee 67 patients of severe mitral stenosis having pliable valve suitable for PTMC on TTE followed by TEE to exclude its contraindications and then finalized for PTMC procedure were enrolled in study after informed consent. PTMC was performed through femoral route using INNOUE balloon. Pre PTMC and post PTMC Right ventricle pressures were measured on table in cath lab. Results: Mean age was 33.8 ± 8.4 with 28.4% (n=19) were male, 71.6% (n=48) were females. 79 % patients had NYHA III symptoms of dyspnea. Mean LA diameter was 50.4mm and mean MVA was 1.02 cm2. 65.7% patients had A.fib before PTMC. Others were in sinus rhythm. Majority of patients had severe pulmonary hypertension before PTMC which had significant reduction (mean 23mmHg) in catheterization lab 10 minutes after PTMC procedure. Conclusion: PTMC is quite effective procedure with significant reduction of not only LA pressure but also of right ventricle indicating its effectiveness from the day of procedure.

Impact of commissural calcification on the immediate result of percutaneous mitral commissurotomy

Percutaneous mitral commissurotomy (PMC) is the treatment of choice of clinically significant rheumatic mitral stenosis with favourable anatomy. However, its indications may be extended to less favourable cases. To determine whether the presence of calcium in the mitral valve commissures influences the immediate result of PMC. PMC by the Inoue balloon was attempted in 247 patients (mean age: 35 years) with severe MS. All the patients had undergone echocardiographic examination before PMC to assess mitral anatomy, commissural calcification (CC) and to determine the Wilkins score. According to the absence or presence of CC, patients were divided into 2 groups: 216 patients in group CC− (no commissural calcification) and 31 patients in group CC+ (presence of calcification in 1 or 2 commissures). Baseline mitral valve area (MVA) was 1 ± 0.19 cm2 (range: 0.5–1.4 cm2), the mean value of Wilkins score was 7.98 ± 1.61 (range: 5–13) and 29 patients had unilateral commissural calcification. Post-PMC success was defined as final MVA ≥ 1.5 cm2 and no mitral regurgitation ≥ grade 3. After PMC, the mean MVA increased to 1.79 ± 0.34 cm2 (P < 0.001) resulting in a success rate of 83%. Severe mitral regurgitation (MR) occurred in 5 patients (2%). Final MVA (1.83 ± 0.32 cm2 versus 1.50 ± 0.36 cm2), success rate (87% versus 55%) and the rate of opening of at least one commissure (97% versus 77%) were significantly different between groups CC− and CC+ (P < 0.001). The rate of post-PMC MR of grade ≥ 3 was not different between the two groups (2% in group CC− and 0% in group CC+; P = 0.6). Our results showed that the presence of commissural calcification was associated with a lower procedural success rate, but a good immediate result could be achieved in half of cases. Then, unilateral commissural calcification should not be considered as a contraindication to PMC.

EFFECT OF PERCUTANEOUS TRANSVENOUS MITRAL COMMISUROTOMY (PTMC) ON RIGHT VENTRICULAR FUNCTION

Objectives: Rheumatic heart disease causes significant morbidity and mortality among the cardiovascular diseases. Mitral stenosis (MS) is the commonest of all rheumatic heart disease. MVR was the definitive treatment for symptomatic mitral stenosis. But after the introduction of percutaneous transvenous mitral valve commissurotomy (PTMC), it is emerged as a safe and effective procedure for the treatment of symptomatic mitral stenosis. To determine the pre and post changes in right ventricular function among patients subjected to percutaneous mitral valve commissurotomy for mitral stenosis.&#x0D; Methodology: This Quasi experimental study was conducted in the Department of Cardiology Hayatabad Medical Complex Peshawar from April, 2021-Oct, 2021. TTE was performed at baseline and PTMC was done in all patients. After PTMC, all patients were kept in CCU for next 24 hours and another TTE was performed at 24th hour after PTMC for measuring changes in the RV function in terms of RVSP, RVOT-FS, RV TEi index, RV wall thickness, pulmonary artery systolic pressure.&#x0D; Results: As per changes in RV parameters before PTMC and 24 hours PTMC, mean and SDs for RVSAP was 5.70+4.50 with P Value 0.000. Mean and SDs for RVOT-FS was -1.22+3.02 with P Value 0.003. Mean and SDs for RV ETi index was 0.14+0.015 with P Value 0.000. Mean and SDs for RV wall thickness was 0.10+0.03 with P Value 0.000. Mean and SDs for pulmonary artery systolic pressure 17.099+4.20 with P Value 0.000.&#x0D; Conclusion: PTMC has significant effect on pre and post changes in right ventricular function amongst patients subjected to percutaneous mitral valve commissurotomy for mitral stenosis.