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Abstract
Since its introduction by Inoue et al. in 1984, PMC has been successfully and safely performed in large series of patients at numerous centers.
Percutaneous mitral balloon valvuloplasty is now the treatment of choice for patients with mitral stenosis and favorable anatomy.
In this study we aimed to evaluate the prognostic value of commissural morphology on immediate and short term outcome after perctaneous balloon mitral valvuloplasty.
The study included 30 patients with symptomatic mitral stenosis schedueled for percutaneous balloon mitral valvuloplasty admitted to department of cardiology and angiology,Alexandria Main University Hospital.
Exclusion criteria:
• Presence of left atrial thrombi on transesophageal echocardiography.
• High echocardiography score.
• Moderate to severe mitral regurgitation,
• Severe calcification of both commissures.
Patients were randomized prospectively into 2 groups:
Group (1): 12 patients with only 1 mitral commissure was opened after PBMV.
Group (2): 18 patients with both mitral commissures were opened after PBMV.
All patients were subjected to thorough history taking and clinical examination, standard 12 lead ECG, Transthoracic echocardiography performed the day before and 24 to 48 hours after the procedure then three monthes after PBMV for evaluation of the following; (MVA,mitral valve score, transmitral gradient, SPAP & commissural opening and calcification) Transeosophageal echocardiography to exclude left atrial thrombi (24 hours before procedure).
PBMV using multitrack system for our 30 patients.
There was no stastical significant differences between the 2 studied groups regarding sex but there was statistical significant difference between the 2 studied groups as regarding age.
Immediate follow up ,no patient developed AF,embolization,severe degree of MR or local site complications.
The mean MVA increased from 0.94+0.19 cm2 to 1.86+ 0.27 cm2 in group 1 & from 0.91+0.18 to 2.29+0.33 cm2 in group 2 with highly statistical significant difference between the 2 studied groups (p=0.001).
The mean Transmitral gradient decreased from 21.83+4.1 to 8.08+2.9mmHg in group (1) and from18.28+5 mmHg to 5.21.76 mmHg in group 2 with significantly statistical difference between the 2 studied groups(p=0.003).
As regared the degree of MR opening of 2 commissures in group 2 had more newly developed MR with no statistical significant difference between 2 groups.
3 monthes follow up,The impact of commissural splitting was reassessed after 3 monthes in all patients.
During follow up no recorded cases of death,hospital admission,redo,or surgery &most of them in NYHA functional class 1-2. *The MVA ranged between (1.6-2.1) with mean 1.8 cm2 in group 1 and ranged between (1.8-3.1) with mean 2.2 cm2in group 2 with highly statistical significant difference between the 2 studied groups (p=0.001). And there was no diffence in MVA between immediate follow up and three monthes follow up.
The mean Transmitral gradient ranged between (3-12) with mean 8.08 mmHg in group 1 and ranged between (3-9) with mean 5.47 mmHg in group 2 with highly statistical significant difference between the 2 studied groups (p=0.001).As seen in table(8)and fig.(19). And there was no diffence in transmitral gradient between immediate follow up and three monthes follow up.
As regared the degree of MR opening of 2 commissures in group 2 had more newly developed MR with no statistical significant difference between 2 groups .As seen in table(9)&fig.( 23). And there was no diffence in degree of mitral regurge between immediate follow up and three monthes follow up.
We concluded that CO degree and MVA are closely related. The degree of CO provides important prognostic information, and complete CO is associated with better late functional results. Thus, degree of CO should be systematically evaluated during and after PMC and can be considered as a complementary measure of the procedural success in addition to the MVA.