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The technique of balloon mitral commissurotomy has evolved rapidly, with improvements in balloons, guide wires, and the application of double-balloon techniques. Percutaneous transvenous mitral commissurotomy (PTMC) using an Inoue balloon catheter is of established efficacy and safety and is an alternative to surgical valvotomy in selected patients with rheumatic mitral stenosis. Patient selection has an important impact on the outcome of percutaneous balloon mitral commissurotomy.
A prospective study was done during the period of August 2003 to November 2015. Nineteen hundred and eighty (1980) patients with rheumatic mitral stenosis who underwent PTMC were evaluated clinically, by echocardiography and by catheter during and after the procedure. Out of 1980 patients, 1320 patients were female (Group-1) and rest 660 patients were male (Group-2).
Mean age of the study population was 24.56 ± 09.85 years in group-1 (female) and 35.34 ± 12.11 years in Group-2 (male). After PTMC mean mitral valve area increased from 0.85 ± 0.11 cm2 to 1.65 ± 0.27 cm2 as measured by echocardiography in group-1 and from 0.80 ± 0.32 cm2 to 1.46 ± 0.33 cm2 in group-2. Mitral valve gradient reduced to 11.63 ± 4.15 mmHg from 26.46 ± 03.94 mmHg after PTMC in group-1 and 12.45 ± 3.76 mmHg from 32.64 ± 04.12 mmHg after PTMC in group-2. Mean left atrial pressure as recorded by catheter before PTMC was 27.92 ± 07.31 mmHg while after PTMC it was 17.81 ± 06.28 mmHg in group-1 and 32.81 ± 07.27 mmHg while after PTMC it was 20.76 ± 05.13 mmHg in group-2.
Male patients are older than female patients at the time of the PTMC procedure, and male patients have worse echocardiographic parameters than female patients.