Percutaneous Transluminal Mitral Commissurotomy Research Articles

Balloon pulmonary valvuloplasty with percutaneous transluminal mitral commissurotomy balloon in pulmonary stenosis

Pulmonary stenosis is common and accounts for 5%–12% of all congenital heart diseases. Echocardiography is the mainstay for evaluating pulmonary stenosis due to its easy availability, reproducibility and non-invasive nature. American Heart Association/American College of Cardiology (AHA/ACC) guideline recommends balloon pulmonary valvuloplasty in patients with moderate to severe valvular pulmonary stenosis. Due to its advantages over other balloons, Inoue and Accura balloon, balloons especially designed for Percutaneous Transluminal mitral commissurotomy can be used for successful balloon pulmonary valvuloplasty.

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.

A Successful Case of Percutaneous Transluminal Mitral Commissurotomy in Acute Heart Failure from Exacerbation of Mitral Stenosis Following Transcatheter Aortic Valve Implantation

A Successful Case of Percutaneous Transluminal Mitral Commissurotomy in Acute Heart Failure from Exacerbation of Mitral Stenosis Following Transcatheter Aortic Valve Implantation

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)

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

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.

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.

The COVID-19 Pandemic Surge and Impact on Rheumatic Valvular Heart Disease Patient Care.

The COVID-19 crisis has surged worldwide, putting immense stress on the health care services, leading to institutions deferring elective procedures and struggling to triage the emergency care of cardiac patients. This has affected the management of the rheumatic valvular heart disease patients especially, in developing countries, potentially placing these patients at enormous risk for complications like congestive cardiac failure, stroke and death. This article explores the COVID-19 pandemic and its impact on rheumatic valvular heart disease patient care. We try to provide a framework that addresses the procedural considerations of interventions like percutaneous transluminal mitral commissurotomy (PTMC), mitral and aortic valve surgeries. This article also highlights the implications for the outpatient valve clinic, and safety issues of the patient and health care workers during this ongoing pandemic.

A Rare Case report on Rheumatic Origin of Severe Tricuspid stenosis

Tricuspid stenosis is a very rare valvular disease due to narrowing of the orifice of the tricuspid valve of the heart. It is usually of rheumatic origin which is accompanied by other valvular lesions. Other causes of tricuspid stenosis include carcinoid syndrome, endocarditis, endomyocardial fibrosis, lupus erythematosus, right atrial myxoma, drug induced and congenital tricuspid atresia. Here we report a patient who had undergone percutaneous transluminal mitral commissurotomy (PTMC) followed by mitral restenosis with Severe Tricuspid Stenosis with Severe Tricuspid Regurgitation.&#x0D;

Percutaneous Transluminal Mitral Commissurotomy in Pregnant Women with Severe Mitral Stenosis

Background: Mitral stenosis tends to worsen during pregnancy because of the increase in the cardiac output and the heart rate. In nonresponders to medical therapy, percutaneous transluminal mitral commissurotomy (PTMC) may be performed when there is a suitable valvular anatomy. In this study, we aimed to investigate the clinical and fetal outcomes of pregnant women with mitral stenosis who underwent PTMC. Methods: Thirty-one patients undergoing PTMC during pregnancy were enrolled in this study. The mitral valve area (MVA), the transmitral valve mean gradient (MVMG), and the severity of mitral regurgitation were assessed pre- and postprocedurally by transthoracic and transesophageal echocardiography. The radiation time was measured during the procedure. The patients were followed up during pregnancy, and the neonates were monitored for weight, height, the head circumference, the birth Apgar score, and the adverse effects of radiation for at least 12 months. Results: PTMC was successfully performed on 29 (93.5%) patients. No maternal death or pulmonary edema was reported. The mean MVA significantly increased (from 0.73±0.17 cm2 to 1.28±0.24 cm2; P<0.001), and the mean MVMG significantly decreased (from 19.62±5.91 mmHg to 8.90±4.73 mmHg; P<0.001) after the procedure. A significant decrease in the systolic pulmonary artery pressure was also detected. Mitral regurgitation did not increase in severity in 16 (51.6%) patients. There was no significant relationship between the Apgar score, weight, height, and the head circumference at birth and at the radiation time. Conclusion: In our series, PTMC during pregnancy was a safe and effective procedure. Lowering the radiation time with low frame-count techniques confers a significant decrease in radiation-related complications.

Regression of right ventricular systolic pressure after successful percutaneous mitral commissurotomy in patients with isolated severe mitral stenosis.

Objective:To know the regression of right ventricular pressure after successful percutaneous transluminalmitral commissurotomy (PTMC) in patients with severe isolated mitral stenosis.Methods:This descriptive study was performed in inpatient and outpatient department of National Institute of Cardiovascular Disease from 1st February 2016 to 31st August 2016. Echocardiography of all patients with successful PTMC were recorded 24 hours and 06 months following PTMC to see for Regression of right ventricular pressure along with other baseline echocardiographic parameters.Results:A total of 99 patients with severe isolated mitral stenosis who had undergone successful PTMC were studied. Females were 65(65.7%) and males 34(34.3%). Mean age was 27.44±6.26 years. TTE performed before and after PTMC showed significant difference in mean mitral valve area (0.89cm ±0.089cm2 vs. 1.68±0.128 cm2, p valve <0.001) and mean left atrial diameter (4.66± .82cm vs. 4.46± 0.65cm). Mean mitral valve gradient pre PTMC was significantly higher (16.38±2.51 mm of Hg) than that of post PTMC 24 hours (4.75±1.31 mm of Hg) and Post PTMC 06 months (5.22±1.21 mm of Hg), p valve <0.001. Mean right ventricular systolic pressure (RVSP) pre PTMC was significantly higher 62.3±10.91 mm of Hg than that of post PTMC 24 hour’s 57.51±9.67 mm of Hg and post PTMC 06 moths 46.49±7.8mm of Hg, p value 0.001. Mean LVEF 50.14± 5.82.Conclusion:There was a significant regression of right ventricular pressure following successful PTMC in mid-term (06 months) follow up of severe isolated mitral stenosis patients.

OUTCOMES OF PERCUTANEOUS TRANSLUMINAL MITRAL COMMISSUROTOMY (PTMC) FOR SEVERE MITRAL STENOSIS IN PREGNANCY

Objective: To know short term outcomes of PTMC for severe isolated mitralstenosis in pregnancy. Methodology: This observational study was performed in Cardiology Unit ofLady Reading Hospital Peshawar from January 2003 to December 2014. Allpatients with symptomatic severe isolated mitral stenosis with no more thanmoderate degree mitral regurgitation were included in the study. They werefollowed till delivery. Results: A total number of 36 pregnant patients undergoing PTMC for isolatedsevere mitral stenosis were included in the study. Mean age was 29±6.3 years.Mild mitral regurgitation was found in 18(50%) of patients, moderate mitralregurgitation in 3(8.3%) while there was no mitral regurgitation in 15(41.7%)patients. Mean mitral valve area was 0.8±0.36 cm . Mean mitral valve gradientwas 23±11 mm of Hg. There mean left atrium size was 4.7±1.2cm. Meanejection fraction was 58.43%. Mean pulmonary artery pressure was 45.8±16.4mmof Hg. PTMC was performed in second trimester in 32(88.88%) patients andin third trimester in 4(11.11%) patients. PTMC was successful in 33(91.6%).Post PTMC mitral valve area was 1.8±0.82cm . The mean mitral valve gradientwas 4±3.2 mm of Hg. Mean left atrium size was 4.61± 2.34 cm. Mild mitralregurgitation was found in 17(47.22%). Moderate mitral regurgitation was foundin 5(13.8%) of patients. Acute severe mitral regurgitation occurred in 1(2.7%)patient, for which emergency mitral valve replacement was arranged but expired.One (2.7%) had still birth. The mean fluoroscopy time was 9.3±7.2 minutes. Conclusion: PTMC is safe and effective procedure for severe symptomatic mitralstenosis in pregnant patients. KeyWords: Percutaneous Transluminal Mitral Commissurotomy (PTMC), MitralStenosis, Pregnancy

Regional quantification of left atrial early diastolic strain in two groups of patients with mitral stenosis: normal sinus rhythm vs atrial fibrillation.

Strain rate imaging (SRI) is proposed for assessing atrial function. There are limited studies on the role of SRI in assessing the left atrial (LA) function in patients with mitral stenosis (MS). We decided to assess LA early diastolic strain to evaluate LA conduit function in two groups of patients with MS. A total of 49 patients with moderate to severe MS, scheduled for percutaneous transluminal mitral commissurotomy, were categorized into two groups: normal sinus rhythm (NSR, n=24) and persistent atrial fibrillation (AF, n=25). Early diastolic strain was measured via SRI in four mid-left atrial walls by transthoracic echocardiography. Left atrial volume was significantly higher in AF group. LA early diastolic strain was significantly reduced in AF patients in three walls: interatrial septum (-6.78±6.22% vs -11.44±6.35%, P=.016), anterior wall (-4.47±4.30% vs -12.52±10.62%, P=.002), and inferior wall (-2.87±3.23% vs -9.73±9.67%, P=.003). After adjustment for age, heart rate, LA volume, LA thrombus, and LAA emptying velocity, there was a significant correlation between the presence of AF and left atrial average early diastolic strain. This correlation was also remarkable between existence of AF and two LA walls (i.e., anterior and inferior walls of the LA). There was reduced average early diastolic strain in the presence of AF compared to NSR in MS patients regardless of LA volume and age. In AF patients, there is not only a loss of atrial late diastolic contraction, but also there is a reduction in early diastolic shortening of LA myocardium.

Emergency mitral valve replacement and cesarean section in parturients: Two case reports

Cardiac surgery during pregnancy using cardiopulmonary bypass has a maternal mortality rate (MMR) of about 3-15%. Cardiopulmonary bypass, in addition, alters placental perfusion, which can increase infant mortality. Here, we report two cases of parturients with severe mitral stenosis, who developed acute mitral regurgitation (MR) after percutaneous transluminal mitral commissurotomy (PTMC) due to anterior mitral leaflet tear. They were posted for emergency mitral valve replacement (MVR) followed by cesarean section. Altering the routine cardiopulmonary bypass and anesthesia protocol resulted in a favorable maternal and fetal outcome.

The Association between B-type Natriuretic Peptide Family and Successful Percutaneous Transvenous Mitral Commissurotomy: A Systematic Review

B-type natriuretic peptide (BNP) level is known to increase in patients with rheumatic mitral stenosis. In this systematic review, we aimed to discuss the possible association between plasma BNP level and the success rate of percutaneous transvenous mitral commissurotomy. PubMed and Scopus databases were searched systematically, using the following key terms: “B-type natriuretic peptide” OR “BNP” AND “percutaneous transvenous mitral commissurotomy” OR “percutaneous transluminal mitral commissurotomy” OR “PTMC” OR “percutaneous balloon mitral valvotomy” OR “PBMV”. The title, keywords and abstract of relevant articles were searched thoroughly. Among 27 articles found in these databases, 18 studies were excluded during different stages of article selection, based on the inclusion and exclusion criteria. A total of 333 patients were evaluated in the selected studies. Overall, 75 and 191 cases were male and female, respectively. Sex ratio was not specified in two studies, evaluating a total of 67 patients. The obtained results showed that BNP level may decrease after a successful PTMC. Furthermore, post-operative plasma levels of BNP and N-terminal proBNP could be considered as predictors of the success rate of PTMC. Based on the results reported in the evaluated articles, there may be an association between post-operative plasma levels of BNP family and the success rate of PTMC.

Use of intracardiac echocardiography to guide percutaneous transluminal mitral commissurotomy: A 20-patient case series.

To report the efficacy and safety of the use adjunctive intracardiac echocardiography (ICE) during percutaneous transluminal mitral commissurotomy (PTMC) in patients without transesophageal echocardiography (TEE). Patients with mitral stenosis are at a high risk of developing a left atrial (LA) thrombus. Traditionally, TEE has been used prior to PTMC to identify the presence of LA thrombi. There have been no reports of the use of ICE to assess the LA for thrombi prior to PTMC. We retrospectively reviewed 20 patients who underwent ICE prior to PTMC. All PTMC procedures were performed via the antegrade transvenous approach using an Inoue balloon. Initially, ICE was used from the right atrium to confirm the absence of a thrombus on the left side of the septum and was subsequently used to guide the transseptal puncture. Following these procedures, the ICE was advanced into the LA through a transseptal sheath to visualize the LAA. Visualization of the thrombus/spontaneous echo contrast was considered to be diagnostic in all cases. Seventy percent of the patients were discharged on day after the procedure. No patients required intubation during the procedure, and there were no complications that could be attributed to the use of ICE. At six months after the PTMC, the incidence of stroke was zero. ICE-guided PTMC offers excellent visualization of the LA and the LAA with satisfactory clinical outcomes and low risk. As a part of the PTMC procedure, ICE safely provides a valid alternative to a separate TEE procedure.

Percutaneous Transluminal Mitral Commissurotomy in Nepalese children with Rheumatic Mitral Stenosis

Background: Rheumatic heart disease is one of the most common heart diseases in developing country; however rheumatic mitral stenosis in children is relatively rare. Percutaneous transluminal mitral commissurotomy is a well established therapeutic intervention for mitral stenosis in adults. The study is conducted to determine the efficacy and safety of PTMC in children with severe mitral stenosis. Methods: A single centre retrospective study is conducted over a 3 and half years period (from 16th November, 2009 to 15th May, 2013) in Shahid Gangalal National Heart Centre, Kathmandu, Nepal. All consecutive patients aged less than 15 years who underwent Percutaneous transluminal mitral commissurotomy for severe mitral stenosis were included. Mitral valve area, left atrial pressure and mitral regurgitation were compared pre and post procedure. Results: During the study period, 2237 patients underwent Percutaneous transluminal mitral commissurotomy. Among them 100 children less than 15 years of age were included. Successful results were obtained in 94 (94%) patients. Mitral valve area increased from 0.7±0.15 cm2 to 1.5±0.32 cm2 (p&lt;0.001). A significant decrease in left atrial pressure was observed from 29±7.9 mmHg to 13.9±6.2 mmHg (p&lt;0.001). There was no significant change in grade of post procedural mitral regurgitation. Conclusions: Percutaneous transluminal mitral commissurotomy in children with severe mitral `stenosis is safe, effective and should be considered as procedure of choice for childrens. Nepalese Heart Journal | Volume 10 | No.1 | November 2013| Pages 23-26 DOI: http://dx.doi.org/10.3126/njh.v10i1.9743

Complete recovery following intra-arterial tenecteplase administration in a woman with acute ischemic stroke

A 23-year-old woman, who underwent a percutaneous transluminal mitral commissurotomy for a tight mitral stenosis, developed an acute ischemic stroke involving the proximal right middle cerebral artery territory. She had a dense left hemiplegia with a National Institutes of Health Stroke Scale score of 12. She was emergently treated within 1hour with intra-arterial tenecteplase and made a dramatic recovery. Intra-arterial tenecteplase is an attractive option for treating acute ischemic stroke with proximal or major vessel occlusion.

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.