Muhammad Atif Imran, Muhammad Ammar Rashid, Naveed Ahmad Shahid, Aamir Hussain, Ahmad Noeman, Shahid Hameed.
Immediate and Midterm Effects of Successful Percutaneous Transvenous Mitral Commissurotomy on Pulmonary Hypertension.
J Cardiovascular Dis Jan ;12(3):67-70.

OBJECTIVE: This study was conducted to assess the immediate and mid-term effects of percutaneous transvenous mitral commissurotomy (PTMC) on pulmonary artery pressure and mitral valve area in patients with mitral stenosis and severe pulmonary-hypertension. METHODS: This Quasi- experimental study was conducted in Cardiology Department, Punjab Institute of Cardiology Lahore from March 2007 to March 2008. It included 60 consecutive patients of tight mitral stenosis with severe pulmonary hypertension diagnosed by echocardiography. PTMC was done by standard lnoue balloon technique. The left atrial pressure and pulmonary artery systolic pressure were also recorded during the procedure. The decrease in pulmonary artery systolic pressure and increase in mitral valve area were recorded immediately and at 3 months after the procedure. The data was analyzed by using software SPSS. The difference between pulmonary artery pressures and mitral valve areas immediately and at midterm follow up were compared by applying paired sample t- test and p value < 0.05 was considered significant. RESULTS: The study included 60 patients out of which 68% were female patients and the mean age was 26 ± 8.6 years. Shortness of breath (NYHA class III in 86.7% patients) was main presenting complaint. Fifty two (86.6%) patients were in normal sinus rhythm and 8 (13.3%) patients had atrial fibrillation and Wilkins score was between 5 and 8. Immediately after PTMC, pulmonary artery systolic pressure decreased from 88 ± 13.7 to 60 ± 12.4 mm Hg on echo (p=<0.001) and 86 ± 13.5 to 58 ± 12.3 mm Hg on cardiac catheterization (p<0.001), mean left atrial pressure decreased from 30 ± 6.7 to 13 ± 7.9 mm Hg (p=0.099) and mitral valve area increased from 0.7 ± 0.1 cm2 to 1.4 ± 0.2 cm2 (p<.001). On midterm follow up mean pulmonary artery systolic pressure was 55 ± 12.4 mm Hg as compared to 60 ± 12.4 mm Hg imndiately after PTMC (p=<0.001). Mean mitral valve area at midterm was 1.6 ± 0.2 cm2 as compared to 1.4 ± 0.2 cm2 immediately after PTMC-(p<0.001). CONCLUSION: It is concluded from this study that PTMC results in increase in mitral valve area leading to decrease in left atrial and pulmonary artery pressure immediately and at mid-term follow up periods. KEY WORDS: Mitral stenosis, pulmonary hypertension, PTMC.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com