Percutaneous Transvenous Mitral Commissurotomy Research Articles

Percutaneous Transcatheter Therapy in a Case of Lutembacher’s Syndrome

Lutembacher’s syndrome is a rare condition and is most often treated surgically. Due to the advances in percutaneous procedures, this form of management is desired which has the advantage of decreased morbidity and is aesthetically superior. In this case report of percutaneous treatment for a Lutembacher’s patient the percutaneous transvenous mitral commissurotomy and atrial septal defect device closure was done with minimal technical difficulties and with excellent post-procedure results.

Study of Percutaneous transvenous mitral commissurotomy outcomes in valves with different Echocardiographic features

BACKGROUND Percutaneous transvenous mitral commissurotomy (PTMC) is now a standard treatment for suitable mitral stenosis. However all procedures are not always successful or optimal. Despite having so much experience on the procedure the prediction as which types of valves give good results after PTMC is not very much defined. METHODS Initial sixty patients of PTMC of Shahid Gangalal hospital (18 male, 42 female), age ranging from 13 to 65 years, mean age 29.9±11.5 years, were studied retrospectively. Their echocardiography data before and after balloon dilatation of mitral valve were collected. The appearance of mitral valve on echocardiogram before PTMC was scored for leaflet thickening, leaflet mobility, subvalvular thickening and calcification. They were categorized into low scoring group A if they scored 8 or low, and high scoring group B if they scored above 8 according to Wilkins score. RESULTS Results were classified as successful and optimal (if valve area > 1.5cm2) or suboptimal (if valve area ≤1.5 cm2). High scoring leaflet deformity with more than 8 was associated with suboptimal results while low score group had successful outcomes and their difference was significant statistically. CONCLUSION Patients with high severity scoring of mitral valve disease had poor outcome in comparison to those with low score.

Comparative outcomes of percutaneous transvenous mitral commissurotomy between low and high Wilkins score.

Percutaneous transvenous mitral commissurotomy (PTMC) is one of the non-surgical methods for patients with significant mitral stenosis. It is less invasive, less complicating with better outcomes compared to surgery. The Wilkins score ≤8 is used to select patients for PTMC, but the results of several studies suggest that PTMC can also be successful in a higher Wilkins score. The aim of this study is to compare the outcomes of PTMC between two groups. In this retrospective study, patients who underwent PTMC between April 2011 and December 2019 were included. Patients were divided into two groups based on Wilkins score: 196 patients (57.64%) with a Wilkins score ≤8 (group I) and 134 patients (39.4%) with a Wilkins score >8 (group II). There was no difference in demographic characteristics between two groups except for age (p = 0.04). Pre and post-interventional echocardiographic and catheterization measurements including left atrial pressure, pulmonary artery pressure, mitral valve area, mitral valve mean, and peak gradient were measured, and there was no difference between the two groups (p > 0.05). The most common complication was mitral regurgitation (MR). Serious complications such as stroke and arrhythmias were rare in both groups (<1%). There was no difference between MR, ASD (atrial septal defect) and serious complications between the two groups. This study shows that the Wilkins score with a cutoff value of 8 is not suitable for patient selection and novel criteria including both mitral valve features and other variables affecting the PTMC outcomes is needed.

Comparative study of percutaneous transvenous mitral commissurotomy using ACCURA balloon in juvenile vs adult rheumatic mitral stenosis

Comparative study of percutaneous transvenous mitral commissurotomy using ACCURA balloon in juvenile vs adult rheumatic mitral stenosis

Left atrial strain predicts improvement in left atrial functions of severe rheumatic mitral stenoses undergoing successful percutaneous transmitral commissurotomy.

Chronic rheumatic heart disease (RHD) is prevalent in India. The mitral valve in isolation or combination with the aortic or tricuspid valve is involved in 31.6% and 52.8% of chronic RHD patients, respectively. The left atrium (LA) functions as a reservoir during the cardiac cycle. Therefore, the LA enlargement leads to longitudinal lengthening, measured as a positive strain, permitting the measurement of the longitudinal strain of LA. This study aimed to assess the LA functions using peak atrial longitudinal strain (PALS) in patients with severe rheumatic mitral stenoses (MS) in sinus rhythm who underwent successful percutaneous transvenous mitral commissurotomy (PTMC). We recruited 56 patients with severe rheumatic MS for the study, of which 06 PTMC procedures were considered unsuccessful. So, 50 patients of chronic severe rheumatic MS in sinus rhythm undergoing PTMC were enrolled in a tertiary care centre of the Armed Forces from August 2017 to May 2019. Patients included in the study were not consecutive, and patients with atrial fibrillation (AF) were excluded. PALS improved post-PTMC (P<.001) in this study, effectively concluding that PALS is impaired in patients with severe symptomatic MS and is acutely enhanced after treatment. PALS is a good indicator of LA function and may predict the success of PTMC on the rheumatic mitral valve.

Extra cardiac perforation following failed percutaneous transvenous mitral commissurotomy

Percutaneous transvenous mitral commissurotomy (PTMC) is the procedure of choice for select patients with mitral valve disease who have favorable valve architecture and meet the requirements for balloon valve dilatation. Complications following PTMC are rare (&lt;3%). A 56-year-old woman with rheumatic valvular heart disease, severe mitral stenosis and moderate mitral regurgitation in atrial fibrillation underwent elective PTMC. She developed an extra-cardiac perforation during PTMC because of abnormal catheter course, and underwent emergency mitral valve replacement with extra-cardiac perforation repair. Catheter-related complications following PTMC are rare but not unheard of. Prompt management of immediate complications result in favorable outcomes.

PROCEDURAL SUCCESS AND IMMEDIATE POST-PROCEDURE COMPLICATIONS OF PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY IN PATIENTS WITH RHEUMATIC MITRAL STENOSIS AT A TERTIARY CARE CENTER

Percutaneous Transvenous Mitral Commissurotomy (PTMC) is a minimally invasive procedure for mitral stenosis. Successful PTMC is achieving a post-procedural mitral valve area (MVA) of ≥1.5 cm2 with echocardiographic mitral regurgitation of less than grade 3–4 post-PTMC. Objectives: The study’s main objective is to assess the Procedural success and Immediate post-procedure Complications like worsening pre-existing mild MR (1) or development of new mitral regurgitation (2) and embolic stroke after the percutaneous transvenous mitral commissurotomy. Methods: This study aimed to evaluate the procedural success of PTMC in patients with mitral stenosis at Hayatabad Medical Complex, Peshawar, from January 2021 to June 2021. Pre-procedure transthoracic echocardiography was performed to determine the mitral valve area, pulmonary artery systolic pressure, trans-mitral pressure gradient, and the presence and severity of mitral regurgitation (MR). The mitral valve area was calculated through planimetry, while the pulmonary artery systolic pressure was measured using Doppler Echo. Results: The mean age of the patients was 42.7 ± 11.5 years, with 23 (28.75%) males and 57 (71.25%) females. The mean mitral valve area before PTMC was 0.97 ± 0.18 cm2, which increased to 1.62 ± 0.17 cm2 after the procedure, and this increase was statistically significant (p=&lt;0.001). The post-PTMC MVA varied with PTMC Wilkin's score, with scores less than or equal to 8 have favorable outcomes. Immediate post-procedure complications were also studied, according to which only 3 (3.75%) out of 80 patients had more than mild MR and none had stroke or TIA. The study concludes that PTMC is an effective and safe treatment option for patients with mitral stenosis, having a favorable Wilkin’s score, resulting in a significant increase in MVA after the procedure. After PTMC, there were mostly minor complications immediately after the procedure that were treated conservatively with good results. Further studies are needed to evaluate the long-term outcomes of PTMC in larger patient populations.

Diagnostic accuracy of total echo score and total commissural morphology score for the prediction of outcome after percutaneous transvenous mitral commissurotomy (PTMC)

INTRODUCTION: Percutaneous transvenous mitral commissurotomy (PTMC), a procedure that treats certain individuals with mitral stenosis, is now frequently used as an alternative to closed surgical mitral commissurotomy (CMC). Cardiologists disagree on which is superior when comparing the total echo score (also known as the Wilkin's score) and the commissural morphology score (TC) for predicting excellent and bad outcomes of PTMC procedures. Therefore, we created this study so that a good predictive score can be used in the future with supporting data before PTMC.&#x0D; AIMS &amp; OBJECTIVE: To evaluate the diagnostic efficacy of the total echo score and the total commissural morphology score for the prognosis following percutaneous transvenous mitral commissurotomy (PTMC).&#x0D; MATERIALS &amp; METHODS: This research was a cross-sectional analysis of patients at the Punjab Institute of Cardiology. This research took place over the course of 6 months, from August 20, 2014 to February 20, 2015. A total of 110 participants participated in the study.&#x0D; RESULTS: The mean age of patients in this study was 43.80 ± 14.18 years with 49(44.5%) males and 61(55.5%) female patients in this study. According to operational definition success of procedure was seen in 103(93.6%) of the patients while 7(6.4%) had unsuccessful procedure. On comparing Total Echo score and “successful procedure” the sensitivity and specificity of Total echo score was 83.5% and 85.71% while PPV and NPV were 98.85% and 26.09% respectively with diagnostic accuracy of 83.64%. The sensitivity and specificity of Commissural score was 92.23% and 57.14% while PPV and NPV were 96.94% and 36.33% respectively with diagnostic accuracy of 90%.&#x0D; CONCLUSION: Total ECO score has high sensitivity, specificity and over diagnostic accuracy but total commissural morphology score has high sensitivity but with less specificity with high diagnostic score. So total echo score can be used as predictive tool for outcome of PTMC in our population&#x0D; KEYWORDS: Rheumatic Heart Disease, Mitral Stenosis, PTMC, Mitral Commissurotomy

Knowledge and Awareness of Rheumatic Valvular Heart Disease among Diagnosed Patients

Objectives: To assess the knowledge about valvular heart disease among the patients who are already diagnosed with rheumatic valvular heart disease (RVHD). Methodology: In this cross-sectional study was conducted at the outpatient of a tertiary care cardiac centre. We included consecutive patients of either gender between 18 to 60 years of age with the established diagnosis of RVHD. Their knowledge and awareness regarding the disease itself and regarding its primary and secondary prevention and treatment options was assessed with the help of a structured self-developed questionnaire. Results: Among the study sample of 505 patients, 255 (50.5%) were male and overall mean age was 37.3 ± 10.9 years. A majority (90.3%) of the patients had household income of ≤ PKR 40,000 and 35.3% were illiterate. More than 41% were not aware of their diagnosis, 40% were aware of childhood infection as the cause of RVHD. About 40% of the patients could not recall history of fever/sore throat in past. About 19.8% of the patients considered percutaneous transvenous mitral commissurotomy as complete cure for RVHD and 46.3% of the patients were not aware of a prophylactic treatment. Only 33.9% considered the need to maintain good dental hygiene as part of the prophylactic treatment. Conclusion: High incidence of lack of awareness regarding their disease and its prophylaxis in our study population is alarming. To improve the RHD awareness, sessions and seminars should be arranged in the general population. Further studies are required to identify the cause and hence identifying measures to improve awareness.

Mid-Term Clinical and Echocardiographic Outcomes of Percutaneous Transvenous Mitral Commissurotomy in Patients with Rheumatic Mitral Stenosis

Introduction: Mitral stenosis is a condition characterized by the narrowing of the mitral valve, which regulates blood flow between the left atrium and left ventricle of the heart. Objectives: The main objective of the study is to find the mid-term clinical and echocardiographic outcomes of percutaneous transvenous mitral commissurotomy in patients with rheumatic mitral stenosis. Material and Methods: The present study was a retrospective observational study conducted at Ayub Teaching Hospital, Abbottabad. The study included a total of 70 patients who underwent percutaneous transvenous mitral commissurotomy (PTMC) between 1st January 2022 and 30th June 2022. Results: A total of 70 patients who underwent PTMC at Ayub Teaching Hospital, Abbottabad, between 1st January 2022 and 30th June 2022 were included in this retrospective observational study. The mean age of the patients was 39.2 ± 12.8 years, and 52 (74.3%) were females. The mean mitral valve area (MVA) prior to PTMC was 0.9 ± 0.2 cm^2 that increased to 1.8 ± 0.3 cm^2 after the procedure, and it was statistically significant (p&lt;0.001). The immediate success rate of PTMC was 94.3%, while the mid-term success rate was 90%. Conclusion: In conclusion, percutaneous transvenous mitral commissurotomy (PTMC) is a safe and effective treatment option for patients with rheumatic mitral stenosis. Our study showed that PTMC resulted in a significant improvement in mitral valve area, trans-mitral pressure gradient, pulmonary artery systolic pressure, and clinical symptoms of dyspnea, fatigue, and palpitations. Keywords: Mitral stenosis, PTMC, Patients, Procedures, MVA

Incidence of Acute Mitral Regurgitation in Patients with Severe Mitral Stenosis after Post Percutaneous Transvenous Mitral Commissurotomy

Aim: To determine the incidence of Acute Mitral Regurgitation in severe mitral stenosis patients done with Post Percutaneous Transvenous Mitral Commissurotomy (PTMC). Methodology: This cross-sectional study was held in the Bahawalpur Heart Center, Bahawalpur for the duration of six months from March 2022 to September 2022. The study included 80 patients, regardless of gender, between the ages of 19-80 years and who had not undergone PTMC. Those with mitral regurgitation and mitral stenosis, left atrial clots, and patients with end-stage renal disease were not included in the study. The predefined Proforma was used as a research tool to document the medical records of PTMC patients. The patient's name, age, echo results, sex, course of treatment, complications and post-procedure information are among the variables documented on the proforma. Results: The patients mean age recorded in this study was 43.18 ± 10.33. The maximum of the PTMC patients, were females 65(80%). The majority of PTMC patients were found to have "Trace" MR, which is a very slight leak in a heart valve. Before the procedure, there were 30 (37.5%) patients with trace MR, followed by 27 (33.8%) patients with mild MR. Before the procedure, 8 (10%) patients had no MR-related difficulties, 5 (6.2%) had moderate MR, and 4 (5%) had mild-moderate MR. After the procedure, 63 (78.8%) of the patients experienced "no complications," 12 (15%) of the PTMC patients experienced "severe mitral regurgitation," 4 (5%) experienced a local hematoma, and cardiac tamponade was seen in one patient. Post-procedure, one patient died. Post-stratification research revealed that 61.3% of patients without a prior history of commissurotomy and the majority of female patients had no complications. While 22.4% of those who never had a prior commissurotomy experienced severe MR overall Conclusion: Our research showed that only a small proportion of PTMC patients had severe mitral regurgitation. Overall, the treatment was successful and safe. Keywords: Cardiac Tamponade, Local Site Complications, Post Percutaneous Transvenous Mitral Commissurotomy, PTMC, Mitral Regurgitation, MR

The Effect of Balloon Mitral Valvuplasty on BNP Plasma Level in Mitral Stenosis

Background: Mitral valve stenosis (MS), which could be progressive, is one of the most important valvular disorders in developing countries. Percutaneous transvenous mitral commissurotomy (PTMC) is a well-accepted treatment option for dealing with symptomatic MS. Brain natriuretic peptide (BNP) has been used as a prognostic marker for clinical outcomes in patients with heart failure and acute coronary syndrome routinely. Objectives: This study aimed to determine the relationship between BNP levels and hemodynamic parameters in patients with MS who underwent PTMC. Methods: In this case-control study, 90 patients with severe isolated rheumatic mitral stenosis and undergoing PTMC were enrolled. In the study group, BNP levels were measured by performing radioimmunoassay on all participants 30 minutes before PTMC and 24 hours after PTMC. Data were analyzed using SPSS, and P-value &lt; 0.05 was considered significant. Results: Fifty patients with MS who underwent PTMC were included in this study. The level of BNP before PTMC was 473.78 ± 66.95 pg/dL in patients with MS. The level of BNP in patients after PTMC reached 341.54 ± 48.3 pg/dL, which was indicative of a significant reduction in the level of BNP after PTMC (P-value = 0.006). Conclusions: A considerable decline was observed in the serum level of BNP following a successful PTMC, which was indicative of an improvement in clinical and hemodynamic status; hence, it was reasonably suggested that the serum level of BNP was effective in evaluating the response from patient with severe MS to PTMC.

A study of Clinical Profile and in Hospital Outcomes of patients undergoing Percutaneous Transvenous Mitral Commissurotomy at a Tertiary Care Center of Nepal.

Rheumatic heart disease (RHD), is a common cause of mitral stenosis (MS) in developing nations. As per current recommendation, Percutaneous Transvenous Mitral Commissurotomy (PTMC) is advised as a Class IA (I-Class Of Recommendation, COR; A-Level Of Evidence, LOE) indication in patients with symptomatic severe mitral stenosis. We aim to examine the clinical profile and in-hospital results of PTMC for mitral stenosis. A cross-sectional retrospective study was conducted at Manmohan Cardiothoracic Vascular and Transplant Center from April 2020 to May 2022. A structured questionnaire was used to collect the data and ethical approval for conducting the study was taken from the Institutional Review Committee (IRC) of Institute of Medicine (IOM). The data was collected in Microsoft Excel (Ver. 2013). For statistical analysis, SPSS 21 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) Association was measured using a parametric and non-parametric test (depending upon the distribution of data) and p value<0.05 was considered significant. A total of 104 patients who met the inclusion criteria underwent PTMC during the study period. The mean age group of the patient was 41.7±12.5 years, of which 23 (22.1%) were males and 81 (78.9%) were females. Mean mitral valve area prior to PTMC was 0.98±0.19mm2 that increased to 1.69±0.19mm2 after the procedure and it was statistically significant (p=<0.001). The post PTMC MVA varied with PTMC Wilkin's score with less than or equal to 8 having favorable outcomes. Successful PTMC is highly influenced by the patients' increasing age, valve morphology (calcification, thickness, mobility), Left atrial dimensions, Pre PTMC mitral valve area, Degree of Baseline mitral regurgitation. Post procedure development of MR is usually well tolerated but rarely be severe enough requiring surgical valve replacement.

Comparison of Outcomes of Different Balloon Sets in Patients undergoing Percutaneous Transvenous Mitral Commissurotomy – Bigger and Differ is Better!

Background: Although the Inoue balloon technique is said to be more popular worldwide for PTMC in those who have severe MS, the Bonhoeffer multi-track (double balloon technique) system is used in our center. On the other hand, it is unknown which balloon set size will produce the best results. The current study's objective is to assess the efficacy of different balloon sets utilized in symptomatic patients with moderate to severe mitral stenosis (MS) following percutaneous transvenous mitral commissurotomy (PTMC).&#x0D; Methodology: There were 203 consecutive patients. In 154 patients, a 14x14mm balloon set was used, and in the other 49 patients, a 14x16mm balloon set. PTMC was deemed successful when MVA 1.5 cm2 was attained with just minimal MR. Patients with valve areas less than 1.5 cm2 and more severe MR are regarded as failed.&#x0D; Results: With a 14x16mm balloon set, post-procedure examination revealed noticeably better accomplishment in the valve area (2.960.84 cm2 versus 3.260.95 cm2; P=0.024). With a 14x16mm balloon set, a tendency towards a lower post-procedure mean pressure gradient across the mitral valve was seen (6.052.19 mmHg versus 5.472.24 mmHg; P=0.107). There was no discernible change in post-procedure MR, tamponade, or procedural failure. However, there was no significant statistical difference in the treatment efficacy between the groups (87.7% with a 14x16mm balloon set versus 77.9% with a 14x14mm balloon set; P=0.153).&#x0D; Conclusion: A 14x16 mm balloon set might be a better and safer option, particularly for taller and older patients with larger annuli.

Multiple sclerosis and mitral stenosis: is there an association? A dilemma

Mitral stenosis is a valvular heart disease defined by narrowing of the mitral valve orifice and is characterized as the most common valvular involvement in developing countries. Although, the most common manifestations of mitral stenosis (MS) include heart failure, stroke, failure to thrive, pulmonary hypertension, and endocarditis, unusual associations occur too. Multiple sclerosis (MS) is a chronic immune-mediated, inflammatory demyelinating disease of the Central Nervous System (CNS) with relapsing-remitting phases due to recurrent episodes of inflammation and demyelination of Central Nervous System (CNS). Some studies found multiple sclerosis patients have a higher prevalence of cardiovascular disease that could be described by coexistence of some common risk factors and etiologies. incidence and prevalence of cardiac valvular disease in these patients were reported 0.7% over a 30 years follow up and 0-2.3% at the time of multiple sclerosis diagnosis, too .There is no proven association between cardiac MS (mitral stenosis) and demyelinating CNS MS (multiple sclerosis), but there have been hypotheses according to case reports and case series. We encountered three cases of mitral stenosis coexistent with multiple sclerosis who underwent appropriate treatment with good outcome and in our facility, we report one of them who had been previously diagnosed with CNS MS and admitted to our hospital with pulmonary edema due to cardiac MS. she underwent Percutaneous transvenous mitral commissurotomy (PTMC), her mitral valve area and systolic pulmonary artery pressure were improved. She is in good condition in both terms of mitral stenosis and multiple sclerosis during follow up. Mitral stenosis and multiple sclerosis, although rare, may occur together. Awareness of it for acceptable diagnosis and treatment and more evaluation in this issue should be noticed.

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.

Does Chronic Inflammation Play a Role in Rheumatic Mitral Valve Restenosis after Percutaneous Transvenous Mitral Commissurotomy?

ABSTRACT&#x0D; Background: Mitral valve restenosis is defined as decreased mitral valve area (MVA) &lt;1.5 cm2 or decreased MVA &gt;50% after PTMC. It is time-dependent and associated with major adverse cardiovascular events (MACE), such as congestive heart failure, cardiac death, mitral valve replacement, and redo PTMC. The mechanism is not yet known; however, chronic inflammation may have a role. Objective: To know the association between chronic inflammation and mitral valve restenosis after PTMC. Methods: A total of 40 patients with mitral valve stenosis who underwent successful PTMC were matched and classified into restenosis/case group (n=20) and no restenosis/control group (n=20). Secondary data was taken from electronic medical records such as patient characteristics (gender, age &amp; 2nd prophylaxis), echocardiography data before PTMC (Wilkins’ score and MVA before PTMC), and echocardiography data after PTMC (MVA after PTMC). Follow-up echocardiography examination (follow-up MVA) and laboratory assessment of chronic inflammation marker (IL-6) were done on all patients. Statistical analyses were done to look for an association between the level of chronic inflammation marker &amp; other independent variables with mitral valve restenosis. Results: Median IL-6 concentration was 2.39 (0.03 – 11.4) pg/mL. There was no statistically significant difference in IL-6 levels between both groups (p-value &gt;0.05). MVA decrement was 0.13 (0 – 0.62) cm2/year with rate of MVA decrement ≥0.155 cm2/year was predictor of mitral valve restenosis (p-value &lt;0.001, OR = 46.72, 95% CI 6.69 – 326.19). Conclusion: Chronic inflammation assessed by IL-6 was not associated with mitral valve restenosis.

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.

Percutaneous transvenous mitral commissurotomy in rheumatic mitral stenosis with atrial dysfunction. Opening the valve…and a window of opportunity

Percutaneous transvenous mitral commissurotomy in rheumatic mitral stenosis with atrial dysfunction. Opening the valve…and a window of opportunity

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.