Waqar Ahmed, Muhammad Khalid Raja, Azeem M, Zameer Rajput, Safder Abbass, Aziz S, Asim Rafique, Faheem Subhani, Azhar Rashid, Afzal S Ahmed, Ashur Khan, Kiani M R.
PTMC in children and adolescents:The AFIC/NIHD Experience - June 95 - Sept 98.
J Pak Inst Med Sci Jan ;7(2)8(1,2):530-5.

Percutaneous Transvenous Mitral Commissurotomy (PTMC) was attempted in 5.9 children and adolescents suffering from symptomatic severe rheumatic mitral stenosis at AFIC/NIHD, Rawalpindi, Pakistan from June 1995 to September 1998. These patients aged 8 to 17 years (mean 13.14 SD 2.50 years). There were 33 females and 26 males. The procedure was successful in 56 patients (94.9%) two patients were put up for surgery on the same day: one had haemopricardium without tamponade, and the other had balloon induced severe mitral regurgitation. The balloon make was Mansfield size 20 mm in 2 patients and Inoue size 20 mm to 28 mm (mean 24.20, SD 2.23 mm) in the rest. The mitral valve area, measured by echocardiography, increased from mean 0.8016 cm2 (SD 0.127 cm2) pre-ballooning to mean 1.873 cm2 (SD 0.4002 cm2), a percent change of 137.21% (SD 6.31 mmHg) to 2.43 mmHg (SD 2.59). The preballooning systolic pulmonary artery pressure was mean 67.12 mmHg, (SD 19.73) mmHg. We entered the pericardium with the needle in three patients, and the aortic root in one. 23 patients (46.9%) did not get any mitral regurgitation. The incidence of procedure induced mitral regurgitation was as follows: no change from pre-ballooning status in 67.3%, increase by grade-1 or less in 28.6% and increase by more than 1 grade in only 4.1 %. There was no sepsis, no thromboembolic episode, and no procedure related death. We conclude that PTMC can be done safely and effectively in children and adolescents, using the Inoue balloon, with minimal complication rate.

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