Percutaneous Mitral Commissurotomy Research Articles

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 & 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.

Abstract 11863: Lutembacher Syndrome - Learning From the Left Atrium

Lutembacher syndrome (LS) is a rare cardiac anomaly that was first reported in 1916 by Rene Lutembacher. LS is characterized by an atrial septal defect (ASD) combined with mitral stenosis (MS), both of which can be either congenital or acquired. Without treatment, pulmonary vascular resistance (PVR) steadily increases and can cause right-to-left ASD shunting. This greatly increases the risk of infective endocarditis (IE) and cerebrovascular accidents (CVA). - We present a 69-year-old female with past medical history of laryngeal cancer that presented with dyspnea and hemoptysis. The patient had NYHA class II symptoms and had not undergone prior cardiac work-up. - Transthoracic echocardiogram demonstrated a reduced ejection fraction 35%, calcifies mitral valve leaflets, and abnormal flow across the interatrial septum. Subsequent transesophageal echocardiogram confirmed the diagnosis of Lutembacher Syndrome with a mean mitral valve gradient of 15 mmHg and evidence of a secundum ASD. There was predominant left-to-right shunting during bubble study with transient right-to-left shunt while coughing. Moderate to severe mitral regurgitation and severe pulmonary hypertension was also observed. Wilkins score was calculated at 7. The patient was ultimately transferred to a Comprehensive Valve Center for surgical mitral valve replacement (MVR). - This case highlights the importance of understanding the pathophysiology of LS for efficient diagnosis and appropriate management. Early evaluation at a Comprehensive Valve Center is recommended. Moderate to severe mitral regurgitation is a contraindication to less invasive options such as a percutaneous mitral balloon commissurotomy (PMBC). It is crucial to recognize that after surgical MVR, the secundum ASD is expected to become smaller with predominant left-to-right shunting due to reduced PVR, which decreases the risk of IE and CVA.

Independent predictors of early mitral valve restenosis after percutaneous transseptal mitral commissurotomy in a large, consecutive cohort– a Machine –Learning -based data analysis from India

Independent predictors of early mitral valve restenosis after percutaneous transseptal mitral commissurotomy in a large, consecutive cohort– a Machine –Learning -based data analysis from India

Rheumatic Heart Diseases: Epidemiological, Diagnostic and Therapeutic Aspects at The Cardiology Clinic Fann Hospital in Dakar

Introduction: Rheumatic heart disease are a serious complication of acute articular rheumatism. They remain frequent in our underdeveloped countries and in Senegal in particular. Late diagnosis and lack of early and appropriate management put people at risk of serious and sometimes fatal complications. The purpose of our study was to report the epidemic profile and outcomes of rheumatic valve disease management. Methodology: We conducted a retrospective and descriptive study including patients hospitalized from January 1st, 2017 to June 31th, 2019 for rheumatic valve disease in cardiac surgery or medical cardiology department. The various parameters studied were epidemiological, diagnostic and prognostic data. Data analysis was done by the Statistical package for Social Sciences (SPSS) version18. Results: We collected 102 cases. The average age was 20.57. The Male/Female sex ratio was 1.12. Fifty-six patients were hospitalized for scheduled surgery, 43 for decompensated heart failure and 03 for infectious endocarditis. Mitral valve regurgitation was the most common valve disease (19.61%). Poly-valvular involvement was dominated by mitral disease and aortic valve regurgitation (32.35%). Seventy-five patients, or 73.5%, had received surgical treatment, including valve replacement in 67.15% of cases and valvuloplasties accounted for 37.83%. Percutaneous mitral commissurotomy was performed in 03 patients. The medical treatment was for heart failure and infectious endocarditis. The trend was favourable in 86.2% of cases. Twenty-eight patients were lost sight. Medium-term mortality was 13.7% or 14 patients. Conclusion: Rheumatic heart diseases remain common in our regions, they must be detected early for better management. The treatment is typically surgical but is often lacking hence the importance of the prevention of rheumatic arthritis.

Combined atrial fibrillation ablation and balloon mitral commissurotomy in patients with rheumatic mitral stenosis.

Ablation of atrial fibrillation (AF) is usually not considered in patients with rheumatic mitral stenosis (RMS). We analyzed the results of a combined procedure of AF ablation and percutaneous balloon mitral commissurotomy (PBMC). We prospectively included 22 patients with severe RMS to undergo a combined PBMC + AF ablation procedure. Noninvasive mapping of the atria was also performed. A historical sample of propensity-scored matched patients who underwent PBMC alone was used as controls. The primary endpoint was freedom from AF/AT at 1-year. Multivariate analysis evaluated sinus rhythm (SR) predictors. Successful pulmonary vein isolation and electrocardiographic imaging-based drivers ablation was performed in 20 patients following PBMC. At 1-year, 75% of the patients in the combined group were in SR compared to 40% in the propensity-score matched group (p = 0.004). The composite of AF recurrence, need for mitral surgery and all-cause mortality was also more frequent in the control group (65% vs. 30%; p = 0.005). Catheter ablation (odds ratio [OR] 1.58; 95% confidence interval [CI] [1.17-17.37]; p = 0.04) and AF type (OR 1.46; 95% CI [1.05-82.64]; p < 0.001) were the only independent predictors of SR at 1-year. Noninvasive mapping in the combined group showed that the number of simultaneous rotors (OR 2.10; 95% CI [1.41-10.2]; p = 0.04) was the only independent predictor of AF. A combined procedure of AF ablation and PBMC significantly increased the proportion of patients in sinus rhythm at 1-year. Noninvasive mapping may help to improve AF characterization and guide personalized AF treatment.

TCT-408 Mitral Valve Long-Term Restenosis After Percutaneous Mitral Balloon Commissurotomy Due to Rheumatic Mitral Stenosis

TCT-408 Mitral Valve Long-Term Restenosis After Percutaneous Mitral Balloon Commissurotomy Due to Rheumatic Mitral Stenosis

Maternal and Fetal Outcomes Following Percutaneous Transluminal Mitral Commissurotomy in Pregnant Women with Critical Mitral Stenosis: An Experience of a Tertiary Care Center from Northern India.

Background:Rheumatic mitral stenosis is the common valvular heart disease seen during pregnancy. Percutaneous transvenous mitral commissurotomy is an effective, safe, and recommended treatment for critical mitral stenosis during pregnancy. We hereby report the maternal and fetal outcomes of pregnant women subjected to percutaneous transvenous mitral commissurotomy at our institute. Methods:Seventy consecutive pregnant women with critical mitral stenosis, who underwent PTMC during the last 10 years, were retrospectively analyzed. All patients had a detailed clinical and obstetric evaluation and were optimally managed with drugs, before the intervention. A comprehensive pre- and post-percutaneous transvenous mitral commissurotomy transthoracic echocardiographic evaluation was performed. Detailed obstetric and fetal outcomes were noted at the time of delivery. Six weeks of post-­partum follow-up was noted in all patients. Results:The mean gestational age at the time of percutaneous transvenous mitral commissurotomy was 29.5 ± 6.68 weeks. Percutaneous transvenous mitral commissurotomy was successful in 97% of patients. Post-percutaneous transvenous mitral commissurotomy New York Heart Association functional class, mitral valve area, trans-mitral pressure gradient, and left atrial pressure had a significant improvement (P < .001). The mean gestational age at the time of delivery was 36.92 ± 3.02 weeks. The mean birth weight of live newborn was 2.29 ± 0.55 kg. The fetal complications include growth restriction in 62.85%, preterm delivery in 34.37%, and low birth weight in 67.21%. A delayed percutaneous transvenous mitral commissurotomy at about 30 weeks of gestation did not affect the maternal and fetal outcomes. Conclusion:Percutaneous transvenous mitral commissurotomy is safe and efficacious in managing pregnant women with critical mitral stenosis. There was a significant improvement in clinical symptoms and echocardiographic parameters following percutaneous transvenous mitral commissurotomy.

Long-term outcomes of severe rheumatic mitral stenosis after undergoing percutaneous mitral commissurotomy and mitral valve replacement: A 10-year experience.

Introduction: Percutaneous mitral commissurotomy (PTMC) and mitral valve replacement (MVR) are treatments of choice for severe rheumatic mitral stenosis (MS). Data regarding the long-term outcomes of patients who underwent PTMC and MVR are limited. Methods: A retrospective cohort study was conducted to evaluate the long-term outcomes of patients with severe rheumatic MS who underwent PTMC or MVR between 2010 to 2020. The primary outcome comprised of all-cause death, stroke or systemic embolism, heart failure hospitalization and re-intervention. Cox regression was used to investigate predictors of the primary outcome. Results: 264 patients were included in analysis, 164 patients (62.1%) in PTMC group and 100 patients in MVR group (37.9%). The majority were females (80.7%) and had atrial fibrillation (68.6%). The mean age was 49.52 (SD: 13.03) years old. MVR group had more age and AF, higher Wilkins’ score with smaller MVA. Primary outcome occurred significantly higher in PTMC group (37.2% vs 22%, P=0.002), as well as, re-intervention (18.3% vs 0%, P<0.001). However, all-cause mortality, stroke or systemic embolism and heart failure hospitalization were not significantly different. In multivariate Cox regression analysis, PTMC (HR 1.94; 95%CI 1.14, 3.32; P=0.015), older age (HR 1.03; 95%CI 1.01, 1.06; P=0.009) and SPAP > 50 mmHg (HR 2.99; 95%CI 1.01, 8.84; P=0.047) were the only predictors of primary outcome. Conclusion: Primary outcome occurred in PTMC group more than MVR group which was driven by re-intervention. However, all-cause mortality, stroke or systemic embolism and heart failure hospitalization were not significantly different.

Percutaneous transluminal mitral valve commissurotomy Via Veno-Arterial loop method.

Background: Since its inception in 1984 by Inoue and colleagues, percutaneous trans venous mitral commissurotomy (PTMC) is the first line treatment option for severe mitral stenosis with favorable valve morphology. Critical mitral stenosis can however pose a challenge for balloon crossing to the left ventricle. Various techniques have been demonstrated to overcome this difficulty. We use a novel technique to cross mitral valve.&#x0D; Case Presentation: We describe a case where critical stenosis of rheumatic mitral valve in a young lady which was not amenable to conventional PTMC procedure, was successfully performed via veno-arterial rail method.&#x0D; Management &amp; Results: After crossing the interatrial septum, mitral valve was tried to cross with the standard technique using Inoue balloon, but failed because the stenosis was very tight. So we have crossed mitral valve through exchanged length terumo wire which was snared in descending aorta and externalized through right femoral artery and then we were able to pass the balloon through the tight mitral valve and the procedure was completed without any complication. Post procedure the pressure gradient dropped to 4mmHg and the mitral valve area was recorded as 1.8cm 2 with 2D echo planimetry.&#x0D; Conclusion: In difficult to cross MV during PTMC, the veno-arterial rail method can be used easily for a successful procedure.

Management of blood and blood components at the Cardinal Stefan Wyszyński National Institute of Cardiology

Background: The clinical activity of the Institute of Cardiology is focused on diagnosis and therapy of coronary artery disease, arterial hypertension, cardiomyopathy, heart failure, acquired and congenital heart defects. On the other hand, interventional cardiology, concentrates on the treatment of acute coronary syndromes, percutaneous aortic valve implantation, transcatheter aortic valve implantation, transcatheter pulmonary valve implantation, percutaneous mitral commissurotomy, percutaneous closure of intra- and extra-cardiac defects as well as carotid, renal and peripheral angioplasty. Material and methods: The study aim was to analyze data and estimate the number of blood/blood component transfusions in the departments of the Institute of Cardiology over a two-year period (1st July 2018–30th June 2020). The data was supplied by the Transfusion Committee (TC) which cooperates with the Blood Bank and the Immunohematology Laboratory. Results: At the Institute of Cardiology, blood and blood components were most often transfused in the 1st Department of Anaesthesiology and Intensive Therapy and in the operating room of the Department of Cardiac Surgery and Transplantology (over 87% of all blood components). Cryoprecipitate was transfused only in the operating room and in the 1st Department of Anaesthesiology and Intensive Therapy. Before and after transplantation, patients were transfused with irradiated leukoreduced packed RBCs, inactivated FFP and pathogen inactivated leukoreduced apheresis PCs. Similar volumes of leukoreduced PCs (47.72%) and leukoreduced apheresis PCs (48.64%) were transfused. Patients allergic to plasma proteins were administered washed blood components (0.15% of all blood components transfused). Conclusions: Rational management of blood and blood components at the National Institute of Cardiology is ensured by following procedures, regular training of personnel and close cooperation between the Regional Blood Transfusion Center in Warsaw, members of the Transfusion Committee, the employees of the Blood Bank and staff of the clinics.