Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov 15:84:104867.
doi: 10.1016/j.amsu.2022.104867. eCollection 2022 Dec.

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

Sutap Yadav  1 , Sangam Shah  2 , Ratna Mani Gajurel  1 , Chandra Mani Poudel  1 , Roshan Ghimire  1 , Nischal Shah  1
Affiliations

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

Sutap Yadav et al. Ann Med Surg (Lond). .

Abstract

Introduction: 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.

Methods: 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.

Results: 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 ± 0.19 mm2 that increased to 1.69 ± 0.19 mm2 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.

Conclusion: 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.

Keywords: AF, atrial fibrillation; BMV, balloon mitral valvotomy; CMC, closed mitral commissurotomy; LA, left atrium; LAP, left atrial pressure; LVEF, Left ventricular ejection fraction; LVSD, Left ventricle systolic dysfunction; MI, Myocardial Infarction; MS, mitral stenosis; MVA, mitral valve area; MVR, mitral valve replacement; Mitral regurgitation; Mitral stenosis; Mitral valve area; NSR, normal sinus rhythm; NYHA, New York Heart Association; Nepal; OMC, open mitral commissurotomy; Outcomes; PA, pulmonary artery; PASP, pulmonary artery systolic pressure; PTMC; PTMC, percutaneous transvenous mitral commissurotomy; RHD, rheumatic heart disease; TTE TEE, Transthoracic Echocardiography Transesophageal Echo.

PubMed Disclaimer

Conflict of interest statement

Authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Outcomes of MVA in comparison to Gender.
See this image and copyright information in PMC

References

    1. Basnet K., Bhattarai S.R., Shah S., Joshi A., Sah S.K., Gami R., Khanal R. Rheumatic heart disease among patients with valvular heart disease admitted to the in-patient department of a tertiary care centre: a descriptive cross-sectional study. JNMA. J. Nepal Med. Assoc. 2022;60:419–424. doi: 10.31729/JNMA.7457. - DOI - PMC - PubMed
    1. Bailey C.P. The surgical treatment of mitral stenosis (mitral commissurotomy) Dis. Chest. 1949;15:377–393. doi: 10.1378/CHEST.15.4.377. - DOI - PubMed
    1. Inoue K., Owaki T., Nakamura T., Kitamura F., Miyamoto N. Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J. Thorac. Cardiovasc. Surg. 1984;87:394–402. doi: 10.1016/s0022-5223(19)37390-8. - DOI - PubMed
    1. Lock J.E., Khalilullah M., Shrivastava S., Bahl V., Keane J.F. Percutaneous catheter commissurotomy in rheumatic mitral stenosis. N. Engl. J. Med. 1985;313:1515–1518. doi: 10.1056/NEJM198512123132405. - DOI - PubMed
    1. McKay R.G., Lock J.E., Keane J.F., Safian R.D., Aroesty J.M., Grossman W. Percutaneous mitral valvuloplasty in an adult patient with calcific rheumatic mitral stenosis. J. Am. Coll. Cardiol. 1986;7:1410–1415. doi: 10.1016/S0735-1097(86)80164-4. - DOI - PubMed