Percutaneous Transvenous Mitral Commissurotomy (Ptmc): Effectiveness In Pulmonary Hypertension With Severe Mitral Stenosis

Abstract

Background: Mitral stenosis, which is caused by the constriction of the mitral valve, is a blockage of blood flow between the left atrium and left ventricle. Reportedly, rheumatic heart illness is the largest cause of mitral stenosis. Due to the thromboembolic phenomenon, left atrial dilatation and stasis related to mitral stenosis may result in the production of thrombus, which may induce cerebrovascular events, coronary embolization, renal emboli, and infarction

Objective:  The study aimed to identify the incidence of reduction of severe pulmonary hypertension in patients with severe mitral valve stenosis 24 hours after PTMC as determined by echocardiography.

Study design: A cross-sectional study

Place and Duration: This study was conducted at The Aga Khan University Hospital Karachi from February 2022 to February 2023

Methodology: We included 105 male and female patients aged more than 15 years and below 60 years reporting severe mitral stenosis having increased pulmonary pressure higher than 50 mmHg being treated with elective PTMC at our hospital.  Success was defined as a reduction in pulmonary hypertension of 1/3 from the baseline. Using SPSS version 21.0, data were analyzed, and all quantifications were made for the appropriate variables.

Results: The PTMC was effective among 96(91.43%) patients. There were 36(34.29%) males and 69(65.71%) females in the study, 34 (32.38%) patients had diabetes and 28 (26.67%) reported having hypertension. The mean BMI was 24.1 SD±1.89, the mean baseline PASP was 69.9 SD ±6.94, and the mean post-PTMC PASP was 41.8 SD ±8.2. We observed that the mean reduction in PASP was 35.3 ±7.29. Diabetes appeared to have a significant association with PTMC effectiveness with a p-value of 0.04.

Conclusion: According to transthoracic echocardiography data, we found that PTMC dramatically lowers pulmonary pressures in the immediate post-PTMC interval. In our study, 91.43% of study participants experienced pulmonary pressure reduction after PTMC.