American Journal of Cardiovascular Disease Research
ISSN (Print): ISSN Pending ISSN (Online): ISSN Pending Website: https://www.sciepub.com/journal/ajcdr Editor-in-chief: Dario Galante
Open Access
Journal Browser
Go
American Journal of Cardiovascular Disease Research. 2021, 7(1), 4-9
DOI: 10.12691/ajcdr-7-1-2
Open AccessArticle

Procedural Success and Immediate Results of Percuteneous Trans Mitral Commissurotomy: An Experience from a Tertiary Care Hospital in Northern Division of Bangladesh

Rahman M1, , Islam MH1, Uddin MB2, Elahi ME3, Mahmud AA1, Awal A4, Barman RN1, Sarkar H1 and Ghafur S1

1Department of Cardiology, Rangpur Medical College & Hospital, Rangpur, Bangladesh

2Department Cardiology, Kushtia Medical College, Kushtia, Bangladesh

3Department of Medicine, M Abdur Rahim Medical College & Hospital, Dinajpur, Bangladesh

4Department of Cardiology, Chittagong Medical College & Hospital, Chattagram, Bangladesh

Pub. Date: July 01, 2021

Cite this paper:
Rahman M, Islam MH, Uddin MB, Elahi ME, Mahmud AA, Awal A, Barman RN, Sarkar H and Ghafur S. Procedural Success and Immediate Results of Percuteneous Trans Mitral Commissurotomy: An Experience from a Tertiary Care Hospital in Northern Division of Bangladesh. American Journal of Cardiovascular Disease Research. 2021; 7(1):4-9. doi: 10.12691/ajcdr-7-1-2

Abstract

Background: One of the ultimate grave consequences of rheumatic heart disease is mitral stenosis. Percutaneous trans-mitral commissurotomy (PTMC) has been practiced with good results in the world since Inoue introduced it in 1982. But in Bangladesh we have very few research-oriented data regarding the effectiveness and patient compliance of this procedure. Aim of the study: The aim of this study was to audit the procedural success, in-hospital outcome in patients undergoing percutaneous trans-mitral commissurotomy (PTMC). Methods: This observational cross-sectional study was conducted in northern division of Bangladesh with the collaboration of the Department of Cardiology, Rangpur Medical College Hospital, Rangpur & Zia Heart Foundation, Dinajpur during the period from February 2018 to November 2019. In total 45 patients who fulfill the inclusion and exclusion criteria for PTMC was enrolled in this study as the study people. Among them the procedural success & immediate results were assessed. Proper written consents were taken from all the participants before starting data collection. A pre-designed questionnaire was used in patent data collection. All data were processed, analyzed and disseminated by MS Office and SPSS version as per need. Result: In our study in analyzing the comparative Echo Doppler data of pre & post PTMC among the participants in both mean (±SD) MVA (cm2) and mean (±SD) MVPG (mmHg) we found extremely statistically significant correlation between pre and post PTMC stages where the P values were less than 0.0001. Besides these, in analyzing the pre & post PTMC hemodynamic and procedural data of participants we observed, against LA Pressure (mmHg) (Mean ± SD), RV Pressure (mmHg) (Mean ± SD), LVEDP (mmHg) (Mean ± SD) and Transmitral PG (mmHg) (Mean ± SD) there were extremely significant correlation between pre and post PTMC stages. In all the parameters the p values were less than 0.0001. Conclusion: We conclude that, percutaneous trans-mitral commissurotomy (PTMC) is a safe procedure in experienced hand with good success rate and optimal results even in patients with special problems like pregnancy, previous CVA and redo cases.

Keywords:
Mitral stenosis (MS) Percutaneous Transmitral Commissurotomy (PTMC) immediate outcome

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Figures

Figure of 3

References:

[1]  M. Mostafa Zaman et al. Prevalence of rheumatic fever & rheumatic heart disease in Bangladeshi children. Indian Heart J 2015; Jan-Feb, 67(1):45-49.
 
[2]  Eisenberg MJ. Rheumatic heart disease in the developing world: prevalence, prevention and control. Euro Heart J 1993; 14(1): 122-128.
 
[3]  Braunwald E. Heart Disease: A text book of cardiovascular medicine. 6th edition. Philadelphia W B Saunders 2001; 291-294.
 
[4]  Movahed MR, Ahmad Kashani M, Kasravi B, Saito Y. Increase prevalence of mitral stenosis in women. J Am Soc Echocardiogr 2006; 19: 911-913.
 
[5]  Ozer O, Davutoglu V, Sari I, Akkoyun DC, Suco M. The spectrum of rheumatic heart disease in the south eastern entolia endemic region. Results from 1900 patients. J Heart Valve Dis 2009; 18: 68-72.
 
[6]  Padamavati S: Rheumatic fever and rheumatic heart disease in developing countries. Bull World Health Org Suppl 1978; 56: 543-550.
 
[7]  Moore P, Adatia I, Spevak PJ, et al: Severe congenital mitral stenosis in infants. Circulation 1994; 89: 2099-2106.
 
[8]  Rizvi SF, Khan MA, Kundi A, Marsh DR, Samad A, Pasha O. Status of rheumatic heart disease in rural Pakistan. Heart2004; 90: 394-399.
 
[9]  Elkayam U, Bitar F. Valvular heart disease and pregnancy part I: native valves. J Am Coll Cardiol 2005; 46: 223-230.
 
[10]  Esteves CA, Munoz JS, Braga S, Andrade J, Meneghelo Z, Gomes N, et al. Immediate and long-term follow-up of percutaneous balloon mitral valvuloplasty in pregnant patients with rheumatic mitral stenosis. Am J Cardiol 2006; 98: 812-816.
 
[11]  Mohmed Ben et al. Percutaneous balloon versus closed and open mitral commissurotomy seven year follow up results of a randomized trial. C circulation 1998; 971:245-250.
 
[12]  Bonow RO, Carabello B, de Leon AC Jr, et al. ACC/AHA guidelines for the management of patients with valvular heart disease: a reportr of the American College of Cardiology/ American Heart Association task force on practice guidelines (committee on management of patients with valvular heart disease). J Am Coll Cardiol 1998; 32: 1486-1588.
 
[13]  Bonhoeffer P, Esteves C, Casal U, et al. Percutaneous mitral valve dilatation with the Multi-Track System. Catheter Cardiovasc Interv Oct 1999; 48(2):178-186 [Medline].
 
[14]  Cribier A, Eltchaninoff H, Koning R, Rath PC, Arora R, Imam A, et al. Percutaneous mechanical mitral commissurotomy with a newly designed metallic valvulotome: immediate results of the initial experience in 153 patients. Circulation Feb 1999; 99(6):793-799. [Medline].
 
[15]  Kaul UA, Singh U, Kalra G, et al. Mitral regurgitation following percutaneous transvenous mitral commissurotomy: a single-center experience. Journal of Heart Valve Disease2000; 9(2): 262-268.
 
[16]  Padial LR, Freitas N, Sagie A, et al. Echocardiography can predict which patients will develop severe mitral regurgitation after percutaneous mitral valvulotomy. J Am Coll Cardiol. 1996; 27(5): 1225-1231.
 
[17]  Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, Freed MD, et al. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; Sep 23. 52(13):e1-142. [Medline].
 
[18]  Topol EJ. Mitral valvuloplasty. Textbook of Interventional Cardiology. 5th. Saunders Elsevier2008; 50.
 
[19]  Joseph G, Chandy S, George P, George O, John B, Pati P, et al. Evaluation of a simplified transseptal mitral valvuloplasty technique using over-the-wire single balloons and complementary femoral and jugular venous approaches in 1,407 consecutive patients. J Invasive Cardiol Mar 2005; 17(3):132-138. [Medline].
 
[20]  Inoue k, Owaki T and Nakamura T. Clinical application of transvenous mitral commissurotomy by a new balloon catheter. Journal of Thoracic and Cardiovascular Surgery 1984;87(3): 394-402.
 
[21]  M S Alkhalifa, Huda H M Elhassam, F A Suleman, Ibtsam A Ali, Tamadur E Elsadig, M K Awad Gasim. Percutaneous Transmitral Balloon Commissurotomy (PTMC): Procedural success and immediate results at Ahmed Gasim Cardiac Center Khartoom Sudan. Sudan JSM. Dec 2006; 1(2): 115-119.
 
[22]  Syed Dawood Md, Rezaul Karim, M. Maksumul Haq, Md Liaquat Ali, Mahbub Mansur Mashhud Zia Chowdhury et al. Percutaneous Transvenous Mitral Commissurotomy. In- Hospital Outcome of Patients with Mitral Stenosis. Ibrahim Card Med J 2011; 1(2): 24-28.
 
[23]  Sher Bahader Khan, Jabar Ali, Rafiullah, Sultan Zeb, Muhammad Irfan, Adnan Mahmood Gul, et al. Percutaneous Commissurotomy (PTMC): Procedural Success and Immediate Results. PJC Jan- June 2013; 24(1,2): 5-10.
 
[24]  Varma PK, Theodore S, Neema PK, Ramachandran P, Sivadasanpillai H, Nair KK, et al. Emergency surgery after percutaneous transmitral commissurotomy: operative versus echocardiographic findings, mechanisms of complications, and outcomes. J Thorac Cardiovasc Surg. Sep 2005; 130(3): 772-776. [Medline].
 
[25]  M. R. Essop, T. Wisenbaugh, J. Skoularigis, S. Middlemost, and P. Sareli, “Mitral regurgitation following mitral balloon valvotomy. Differing mechanisms for severe versus mild-tomoderate lesions. Circulation. 1991; 84(4): 1669-1679.
 
[26]  Wang A, Krasuski RA, Warner JJ, Pieper K, Kisslo KB, Bashore TM, et al. Serial echocardiographic evaluation of restenosis after successful percutaneous mitral commissurotomy. J Am Coll Cardiol. Jan 2002; 39(2): 328-334. [Medline].
 
[27]  Fawzy ME, Shoukri M, Al Buraiki J, Hassan W, El Widaal H, Kharabsheh S, et al. Seventeen years’ clinical and echocardiographic follow up of mitral balloon valvuloplasty in 520 patients, and predictors of longterm outcome. J Heart Valve Dis. Sep 2007; 16(5): 454-460. [Medline].