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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. The technique of balloon mitral commissurotomy has evolved rapidly, with improvements in balloons, guide wires, and the application of double-balloon techniques. So, we aimed to assess the immediate in-hospital complications of percutaneous transvenous mitral commissurotomy (PTMC) in patients with symptomatic moderate to severe rheumatic mitral stenosis in our population.
: A prospective study was done in National Institute of Cardiovascular Diseases, Dhaka, Bangladesh and Al- Helal Heart Institute, Mirpur, Dhaka 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.
After PTMC mean mitral valve area increased from 0.83 ± 0.11 cm2 to 1.76 ± 0.27 cm2 as measured by echocardiography. Mitral valve gradient reduced to 11.63 ± 4.15 mm Hg from 28.46 ± 03.94 mm Hg after PTMC. Mean left atrial pressure as recorded by catheter before PTMC was 30.99 ± 08.37 mm Hg while after PTMC it was 13.81 ± 06.28 mm Hg. There was no procedural death. There were 4 patients in- hospital death. 2 patients died from massive CVD after PTMC. 1 patient died from renal failure and electrolyte imbalance, 1 patient died from multisystem organ failure due to sepsis unrelated to PTMC. There were 2+ mitral regurgitation in 3 patients or 3+ post PTMC mitral regurgitation in 1 patient as assessed by left ventriculography. There was no A-V block during or after PTMC.
Pericardial tamponade occurred in 5 patients post procedure and those patients were successfully treated with pericardiocentesis in the catheterization laboratory under echo guidance and PTMC was completed successfully. Thromboembolic events occurred in 04 patients and in 2 patients massive CVD and in 2 patients TIA. Left to right shunt (ASD) occurred in 30 patients.
Local vascular complications like pain, hemorrhage, hematoma occurred in 69 patients.
PTMC is a very effective and safe procedure at relieving the hemodynamic effects of rheumatic mitral stenosis. Complications during the procedure was very few.