Abdul Malik, Riaz Anwar Khan, Syed Murad Ali Shah, Abid Aslam Awan, Sohail Aslam, Khalid Rehman, Nayyar Waseem, Javaid Nawab, Taskeen Ahmad, Hamid Ahmad, Parvez Mannan.
Should we say good bye to closed Mitral Commissurotomy in our setup.
J Postgrad Med Inst Jan ;19(2):144-8.

Objectives: To study the short-term results of closed mitral commissurotomy in patients with rheumatic mitral stenosis. Material and Methods: This study was conducted at the department of cardiovascular surgery, Lady Reading Hospital, Peshawar from January 2003 to December 2003. Data was collected on a preformed proforma. Mitral valve characteristics were evaluated according to the scoring system devised by Wilkins and Associates. All those patients who had severe mitral stenosis and echo score of < 12, raised pulmonary hypertension or patients with atrial fibrillation were included in this study. Patients having echo score > 12, left atrial & left atrial appendage clot, moderate mitral regurgitation were excluded from the study. After operation patients were followed up for six months for haemodynamic stability. Results: During this time period, 76 patients with rheumatic mitral stenosis underwent closed mitral commissurotomy. Total patients were 76 (male 18, female 58) with age range of 10 to 60 years. Pre-op 2 2 mitral valve area ranged from 0.6 to 01 cm a mean of 0.74 + 0.13 cm . Mean mitral valve gradient was 19.7 + 6.3 mm Hg. Pulmonary artery systolic pressure ranged from 35-110 mmHg. Five patients had associated severe tricuspid regurgitation. Twenty patients had controlled atrial fibrillation. At two weeks follow-up in the out patients department after closed mitral commissurotomy the mean mitral valve 2 gradient was 9.4 + 4.2 mmHg and mitral valve area was 1.6 ± 0.7 cm . One patient developed severe mitral regurgitation and one had left hemperesis. Pulmonary artery systolic pressure assessed by Doppler, dropped to a mean of 40 mmHg. There was no death. At six months follow-up the improved haemodynamics were maintained. Cost of the whole procedure was less than the cost of the percutaneous transmitral commissurotomy catheter alone. Conclusion: Closed Mitral Commissurotomy is a safe procedure. It is cost effective in developing countries with limited health budget, closed mitral commissurotomy still has a role to play.

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