Predictors of successful percutaneous transvenous mitral commissurotomy using the Bonhoeffer Multi-Track system in patients with moderate to severe mitral stenosis: Can we see beyond the Wilkins score? (original) (raw)
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Cardiovascular Journal, 2012
Background: The aim of this study was to evaluate the immediate impact of Percutaneous Transvenous Mitral Commissurotomy (PTMC) on RV function in patients with mitral stenosis (MS).Methods: This study was conducted in the National Institute Cardiovascular Diseases, Dhaka for a period of one year starting from October 2008 to September 2009. A total of 50 consecutive patients (Case group) with mitral stenosis were selected after considering inclusion and exclusion criteria that subsequently undergone PTMC. The control group (n=50) consisted of age and sex matched healthy individual (having no ECG or echocardiographic evidence of structural or functional cardiovascular disease). Healthy control group was taken because there was no data about RV function in our population. Control group used to compare with baseline characteristics of case group.Results: Immediately after PTMC (24 to 48 hours) mitral valve area increased from 0.8± 0.1 to 2.0 ± 0.2 (p <0.001) and RV outflow tract fra...
Immediate impact of percutaneous transvenous mitral commissurotomy on right ventricular function
Nepalese Heart Journal
Background and Aims: Abnormal Right Ventricular (RV) function affects the long term outcome and clinical symptoms in patients with mitral stenosis (MS). This study evaluates the immediate effect of Percutaneous Transmitral Commisurotomy (PTMC) on RV function.Methods: An observational, cross sectional study was done on 50 patients with rheumatic MS who underwent PTMC at Shahid Gangalal National Heart Center from Dec 2015 –Dec 2016. All underwent clinical evaluation and echocardiogram before and immediately after PTMC.Results: There was female preponderance with 66% being female. The mean age was 37.26 ± 10.63 years. There was immediate increase in the mitral valve area (MVA) from 0.87 ± 0.12cm2 to 1.54 ± 0.27cm2(p< 0.001). There was significant decrease in mean mitral diastolic gradient from 16.4 ± 8.8mmHg to 5 ± 1.5mmHg (p< 0.001), in the pulmonary artery systolic pressure 53.6 ± 21.83mmHg to 39.5 ± 14.67mmHg (p< 0.001), in the RV Tei index from 0.56 ± 0.08 to 0.40 ± 0.08 (...
Outcome of Percutaneous Transvenous Mitral Commisurotomy According to Age, Gender and Heart Rhythm
Journal of National Heart and Lung Society Nepal
Background: Percutaneous transvenous mitral commisurotomy (PTMC) is the recommended treatment in the severe mitral stenosis with mitral valve area ≤ 1.5 sq. cm and favourable mitral valve morphology without Left atrium (LA) clot. Methods: A retrospective study done for one year among all the patients who had undergone PTMC in 2016. Successful PTMC was defined as increase in Mitral valve area (MVA) more than or equal to 1.5 sq. cm or increase in area by more than 50% from baseline. Data was analyze using SPSS-20. Results: Three hundred thirty sex patients with mean age 34.08 ±12.0 of which male were 97 ( 26.9 %.) and female were 239 (71.1 %). There were 225 (67%) sinus rhythm (SR) and 111 (33%) atrial fibrillation (AF). The median Pre PTMC area and Left atrial (LA) Pressure were 0.9 sq cm and 24 mmHg respectively. The overall success of PTMC was in 289 (86%). The successful outcome in age categories less than 20 years, 20-40, 40-60 and more than 60 years in order are 39 (83%), 174 (8...
University Heart Journal, 2015
Mitral stenosis (MS) is a disabling and eventually lethal disease. Untreated progressive disease can lead to significant symptoms and serious complications. The great majority of cases in adults are due to rheumatic heart disease, with symptoms usually appearing 16 to 40 years after the episode of acute rheumatic fever. According to the annual report by the World Heart Federation, an estimated 12 million people are currently affected by rheumatic fever and rheumatic heart disease worldwide, prevalence of rheumatic heart disease, reporting 0.14/1000 in Japan (Kawakita 1986), 1.86/1000 in China 20 0.5/1000 in Korea 18 , 4.54/1000 in India 1 , and 1.3/1000 in Bangladesh 2. Among them mitral valve is affected in 75% cases. Abnormalities of right ventricular function (RVF) play an important role in the development of clinical symptoms and the overall prognosis of the patients with mitral valve stenosis (MS) 4,14. RVF may be affected by the Rheumatic process directly (Borer, Hochreiter & Rosen 1991) or through hemodynamic changes due to pulmonary vascular
Mini-invasive Surgery , 2020
A growing body of evidence shows that transcatheter mitral valve edge-to-edge repair (TMVr) for mitral regurgitation (MR) improves symptoms and prognosis of patients with heart failure. Still, as recently shown by two large randomized controlled trials (COAPT and MITRA-FR), there is differing information on which patients have the largest benefit. We aimed to summarize the current knowledge of clinical and anatomic predictors for acute procedural failure and long-term all-cause mortality after TMVr. TMVr is an effective treatment option for patients with symptomatic MR fulfilling certain echocardiographic and clinical criteria or being ineligible for surgery despite optimal medical therapy. Acute procedural failure is influenced by anatomic features of the mitral valve, among those are increased tenting and mitral valve leaflet configuration, leaflet-to-annulus index, as well as the mitral valve opening area. In contrast, anatomy of the mitral valve plays a minor role in predicting all-cause mortality after TMVr. This endpoint is associated with patient comorbidities (e.g., renal failure and chronic lung disease), severe heart failure as expressed by New York Hear Association functional class (NYHA) IV, left and right heart dysfunction, laboratory parameters (NT-proBNP), clinical scoring systems (STS and EuroScore), and procedural MR reduction. In patients undergoing TMVr for severe MR, careful preprocedural evaluation of relevant comorbidities, mitral valve anatomy, as well as left and right heart function can provide detailed prognostic value regarding acute procedural success and long-term survival.
Japanese Circulation Journal, 1999
ercutaneous transvenous mitral commissurotomy (PTMC) has been established as a reasonable treatment of choice since its first introduction as a clinical application. 1 In the majority of mitral stenosis (MS) patients, PTMC provides good immediate improvements of both cardiac hemodynamics and clinical symptoms. 2-14 However, there are few published reports concerning the long-term outcome of mitral valve area (MVA), clinical events and the functional limit of daily activities. 15,16 Because most of the previous studies were retrospective, they provides limited information on post-procedural exacerbation. Moreover, few studies have been done in a single laboratory with a uniform technique. We report the long-term results after successful PTMC using the single-balloon technique, performed and then evaluated in the same institution. The annual follow-up was focused on the MVA and clinical events. Methods Study Patients From June 1987 to December 1990, 132 patients underwent PTMC in Mitsui Memorial Hospital. Achievement of either a MVA >1.5 cm 2 or a MVA of more than twice the pre-PTMC value was a requirement for procedural success. Another requirement was the absence of exacerbated mitral regurgitation (MR) of grade of 2+ or more by Sellers clas
Acute haemodynamic changes after percutaneous mitral valve repair: relation to mid-term outcomes
Heart, 2012
Background Percutaneous mitral valve repair (MVR) using the Evalve MitraClip has been recently introduced as a potential alternative to surgical MVR. Objective To assess immediate haemodynamic changes after percutaneous MVR using right heart catheterisation. Design Single-centre longitudinal cohort study. Setting Tertiary referral centre. Patients Fifty consecutive non-surgical patients (age 74614 years, EuroSCORE 26614) with moderate to severe (3+) and severe (4+) mitral regurgitation (MR) due to functional (56%), degenerative (30%) or mixed (14%) disease were selected. Interventions MitraClip implantation was performed under general anaesthesia with fluoroscopy and echocardiographic guidance. Haemodynamic variables were obtained before and after MVR using standard right heart catheterisation and oximetry. Main outcome measures Haemodynamic changes immediately before and after MVR. Results Acute procedural success (reduction in MR to grade 2+ or less) was achieved in 46 (92%) patients. Mitral valve clipping reduced mean pulmonary capillary wedge pressure (mPCWP) (from 1767 to 1265 mm Hg), PCWP v-wave (from 24611 to 1667 mm Hg) and mean pulmonary artery pressure (mPAP) (from 29612 to 2466 mm Hg), and increased the cardiac index (CI) (from 3.161.0 to 3.961.1 l/min/ m 2) (all p<0.05). On Cox univariate regression analysis, mPCWP, PCWP v-wave-and mPAP-changes were associated with death, open-heart surgery for MR and/or hospitalisation for heart failure on follow-up. Conclusion In a heterogeneous population with predominantly functional MR, percutaneous MVR with the Evalve MitraClip system lowers mPCWP, PCWP v-wave and mPAP by 20%, 20% and 8%, respectively, and increases the CI by 32%.
Journal of the American College of Cardiology, 2002
The optimal timing of surgical correction of severe mitral regurgitation (MR) is important for improved morbidity and mortality. We utilized a scoring system to decide the timing of procedures. Based on clinical features and echocardiographic data, we hypothesized that preoperative semi-quantitation of MR using this scoring system may be useful for predicting prognosis after repair. The MR score was composed of 6 parameters associated with disease severity (i.e., history of heart failure, atrial fibrillation, pulmonary hypertension, left ventricular end-systolic dimension, fractional shortening, and left atrial dimension). The maximum score was 6. Of 267 patients who underwent mitral valve repair in the last 10 years, 191 patients with mitral valve prolapse were studied. Patients were categorized into 2 groups accord-ing to MR score (group low [L] : 0 to 2.5 and group high [H]: >3.0) irrespective of New York Heart Association functional class. A significant difference in postoperative event-free survival was observed between both groups (p ؍ 0.0014); the adjusted risk ratio was 3.4 (95% confidence interval 1.6 to 7.2). Postoperative echocardiography showed larger left ventricular systolic dimensions (p <0.0001), lower fractional shortening (p ؍ 0.0016), and larger left atrial dimensions (p <0.0001) in group H than group L. Thus, an MR score is a simple way to predict the prognosis of severe MR independently of subjective symptoms in patients undergoing mitral valve repair. ᮊ2003
Prognostic Role of Right Ventricle in Mitral Valve Surgery for Ischemic Mitral Regurgitation
Background: To evaluate if preoperative right ventricular (RV) dilatation or dysfunction may affect mid-term cardiac mortality of patients with ischemic mitral regurgitation (IMR) undergoing mitral valve surgery (MVS), independently from pulmonary hypertension (PH). Methods: From March 2006 to March 2010, 172 patients with IMR, electively and consecutively operated on by a single surgeon (AMC) were enrolled in this study. Tricuspid annular plane systolic excursion (TAPSE) was used to evaluate RV function. Right ventricular end-diastolic diameter (RVEDD) was also evaluated. Results: Twenty-seven patients (15.7%) died by 5 years for any cause, 22 (12.8%) due to cardiac cause. ROC curve identified two predictive cut-offs: TAPSE≤15mm (AUC=0.87, sensitivity=91%, specificity=81 %,) and RVEDD>35mm (AUC=0.84, sensitivity=86%, specificity=82%). An “abnormal” RV, defined as either RV dilatation or dysfunction, was found in 66 (38%) of cases, preoperatively. Right ventricle was normal in 106 cases. Five–year overall cardiac survival was 85%±3 (normal 99%±1 versus abnormal RV 63%±7, p<0.001). This result was also confirmed by a multivariate analysis. Cardiac survival in patients without PH was 90%±4 versus 88%±3 in patients with any grade of PH (p = 0.812). The presence of an abnormal RV was a risk factor in patients both with and without PH; while the presence of PH was a risk factor neither in patients with normal nor abnormal RV. Conclusions: : Right ventricular dysfunction and dilatation should be considered in risk stratification model; both conditions are able to impair cardiac mortality, independently from PH.
American Journal of Cardiology, 2007
The aims of the echocardiographic substudy of this multicenter trial were to evaluate the use of quantitative assessment of mitral regurgitation (MR) severity using serial echocardiography and to assess the efficacy of percutaneous mitral valve repair. Previous surgical repair studies did not use quantitative echocardiographic methods. Results of a percutaneous mitral valve repair clip device in a core echocardiographic laboratory were evaluated. Published parameters for quantifying MR were used in a systematic protocol to qualify patients for study entry and evaluate treatment efficacy at discharge and 6 months after clip repair. Baseline results were presented for 55 patients, and follow-up results, for 49. Ninety-eight percent of required echocardiographic studies were submitted to the core laboratory, and >85% of required measurements were possible. At baseline, mean regurgitant volume was 54.8 ± 24 ml, regurgitant fraction was 46.9 ±16.2%, effective regurgitant orifice area was 0.71 ± 0.40 cm2, and vena contracta width was 0.66 ± 0.20 cm. Based on a severity scale of 1 to 4, mean color flow grade was 3.4 ± 0.7, and mean pulmonary vein flow was 2.8 ± 1.2. In patients with a clip at 6 months, all measurements of MR severity were significantly decreased versus baseline, with mean regurgitant volume decreased from 50.3 to 27.5 ml (change −22.8 ml; p <0.0001), regurgitant fraction from 44.6% to 28.9% (change −15.7%; p <0.0001), color flow grade from an average of 3.4 to 1.8 (change −1.6; p <0.0001), and pulmonary vein flow from 2.8 to 1.8 (change −1.0; p <0.0018). In conclusion, quantitative assessment of MR is feasible in a multicenter trial, and percutaneous mitral repair with the MitraClip produces a sustained decrease in MR severity to moderate or less for ≥6 months.