Author + information
Percutaneous Transvenous mitral Commissurotomy (PTMC) is an established non-surgical modality for the treatment of severe rheumatic mitral valve stenosis. Until the mid-1980s, surgical closed or open commissurotomy was the only available treatment. However, mitral valve surgery in children and adolescents, in addition to its acute risks, has the added disadvantage that because the initial surgery is performed at an early age, reintervention may be necessary. So, aim of this study was to evaluate the safety, efficacy and in-hospital results of percutaneous transvenous mitral commissurotomy in young patients with severe rheumatic mitral stenosis.
Materials and Methods
The study group included 360 consecutive patients who underwent PTMC at the National Institute of cardiovascular Diseases (NICVD), Dhaka and Al -Helal Heart Institute, Mirpur, Euro-Bangla Heart Hospital, Lalmatia, Dhaka between May 2003 and December 2012. Safety, efficacy and in-hospital results of percutaneous transvenous mitral commissurotomy were analyzed in 48 patients 20 years old or younger (group 1) and compared with 312 those of adults (group 2).
Young patients were less frequently in atrial fibrillation (5.9% vs. 32.4%, P<0.001) and had less mitral valve deformities, echo score: >8 (14.6% vs. 32.4%, P<0.0001). Mitral valve area index by 2D-echo was of 0.62± 0.18cm2/m2in group 1 and 0.61±0.19cm2/m2in group 2 (P=ns) and was larger in group 1 (1.54 ±0.6 cm2/m2 vs. 1.29 ±0.5 cm2/m2) after the procedure (P<0.001). Procedural success was obtained in 47 (97.9%) patients of group 1 vs. 284 (91.02%) patients of group 2 (P<0.001). There was no procedural death in both groups. There are 2 (0.64 %) in hospital death in group-2 and no death in group-1. In group-2, 1 patient died from massive CVD after PTMC and 1 patient died from renal failure and electrolyte imbalance.
Percutaneous transvenous mitral commissurotomy is safe and effective procedure in young with rheumatic mitral stenosis and provides better immediate echocardiographic and in-hospital results than in adults.