PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY IN PATIENTS WITH RHEUMATIC HEART DISEASE: A HOSPITAL-BASED RETROSPECTIVE STUDY

Received 2021-05-29; Accepted 2021-11-25; Published 2022-07-01

Abstract

Background: Percutaneous Transvenous Mitral Commissurotomy (PTMC) is a procedure of choice for the treatment of severe mitral stenosis. We aimed to describe our experiences on management of rheumatic heart disease with PTMC in Malaysia.

Methods: Patients who underwent PTMC were traced through the electronic medical record of University Malaya Medical Centre. The patients detailed echocardiogram parameter pre-procedure, post-procedure and outcome were documented. Statistical analysis was performed using SPSS version on 18 for windows.

Results: 11 patients were treated with PTMC in our centre with 90.9% (n=10) success rate. Subjects underwent PTMC were statistically significant associated with improved echocardiogram parameters as following: increase in mitral valve size (p=0.0058) from 0.89 ± 0.2 cm2 (pre) to 1.4 ± 0.4 cm2 (post); reduction in mean pressure gradient across mitral valve (p=0.0283) from 11.5 ± 4.9 mmHg (pre) to 6.9 ± 3.5 mmHg (post); and reduction (p=0.0019) in elevated pulmonary artery systolic pressure from 65.7 ± 21.4 mmHg (pre) to 45.6 ± 10.0 mmHg (post). More than half (62.5%, n=5) of the subjects with favourable Wilkin score 8 or less achieved good outcome defined as post-PTMC mitral valve size ≥ 1.5 cm2 . All subjects with unfavourable Wilkin score of more than 8 only achieved sub-optimal post-PTMC mitral valve size ≤ 1.5 cm2 .

Conclusion: Given the minimally invasive nature of PTMC with comparable excellent haemodynamic outcome to invasive vascular repair, PTMC should be the recommended first line therapy in mitral valve stenosis.