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To see the immediate hemodynamic and echocardiographic results of Percutaneous Transvenous Mitral Commissurotomy (PTMC) in patients with mitral stenosis with mitral annular calcification.
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. Mitral annular calcification (MAC) is degenerative, fibrous calcification of the mitral valve annulus. Wilkins scoring system does not examine MAC, which is characterized by calcium and lipid deposition within the annular fibrosa of the mitral valve and might independently influence the PTMC result .
A prospective study was done during the period of August 2003 to June 2017. One Thousand Nine hundred and eighty (1980) patients with rheumatic mitral stenosis who underwent PTMC were evaluated clinically, by echocardiography and by catheter, during and after procedure. Out of 1980 patients, 120 patients had mitral annular calcification (Group-1) and 1860 patients had no mitral annular calcification (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.
PTMC is an effective procedure for patients with mitral annular calcification, but the result is inferior to patients with no mitral annular calcification .So, mitral annulus evaluation may be considered in the echocardiographic assessment of the mitral apparatus prior to PTMC.