Author + information
- Toufiqur Rahman1
Rheumatic fever and rheumatic heart disease continue to be the major health problem in all developing countries including Bangladesh. Rheumatic mitral stenosis is a very common problem in our population having an incidence of 54 percent among rheumatic heart disease with a female preponderance of 2:1. Percutaneous balloon mitral commissurotomy is appealing because the mechanism of valve dilation closely parallels the mechanism of surgical mitral commissurotomy We aimed to see the immediate echocardiographic and hemodynamic outcome of percutaneous transvenous mitral commissurotomy (PTMC) in 50 patients who were ≥ 50 years of age.
A prospective study was done during the period of August 2003 to June 2014. Nine hundred and ninety (990) patients with rheumatic mitral stenosis who underwent PTMC were evaluated clinically, by echocardiography and by catheter during and after procedure. Out of 990 patients 60 patients aged ≥ 50 years (Group-1) and rest 930 patients aged <50 years (Group-2).
Mean age of the study population was 54.25 ± 02.80 years in group-1 and 26.14 ± 11.21 years in Group-2 . Most of the population are female, 70% in Group-1 and 78% in group-2. After PTMC mean mitral valve area increased from 0.80 ± 0.11 cm2 to 1.46 ± 0.27 cm2 as measured by echocardiography in group-1 and from 0.85 ± 0.32 cm2 to 1.81 ± 0.33 cm2 in group-2 . Mitral valve gradient reduced to 11.63 ± 4.15 mm Hg from 32.46 ± 03.94 mm Hg after PTMC in group-1 and 10.45 ± 3.76 mm Hg from 26.64 ± 04.12 mm Hg after PTMC in group-2 . Mean left atrial pressure as recorded by catheter before PTMC was 33.99 ± 08.37 mm Hg while after PTMC it was 23.81 ± 06.28 mm Hg in group-1 and in group -2, 28.81 ± 07.32 mm Hg before while after PTMC it was 21.76 ± 05.11 mm Hg in group-2.
PTMC can be performed effectively and safely in selected patients ≥50 years old with good immediate result but result is inferior to young patients. In addition to clinical examination, echocardiographic evaluation of the mitral valve and fluoroscopic screening for valvular calcification are the most important steps in patient selection for successful outcome.
STRUCTURAL: Valvular Disease: Mitral