Background: Percutaneous Transvenous Mitral Commissurotomy (PTMC) procedure is best applied to symptomatic patients with moderate-to-severe mitral stenosis (mitral valve area <1.5 cm2) and favorable mitral valve morphology. The aim of this study is to determine the outcome of patient who underwent PTMC among patients with moderate to severe MS, with moderate MR and to determine the predictors of outcome.
Method: This is a Retrospective Cohort Study. A total of 91 subjects were included in the study. Records were reviewed retrospectively among who underwent PTMC admitted from January 2010 up to September 2014. Demographic characteristics were collected such as Age, Gender, Wilkins score, co-morbidities, and echocardiographic parameters pre and post PTMC such as Mitral valve area, LVEF, Mitral valve peak gradient, Mitral valve mean gradient and Systolic Pulmonary Arterial Pressure.
Results: A success rate of 79% (72 out of 91 of patients achieved post-procedural MVA > 1.5 cm2 and MVA increase of at least 50%) was achieved among patients with Moderate to Severe Mitral Stenosis with Moderate Mitral Regurgitation. Among patients with successful PTMC, 62/91 (86.11%) were all females, the mean age was 39.25 ± 11.01 and an average Wilkin score of 8.2 ± 0.79. Among those with unsuccessful PTMC, 12 (63%) have Atrial Fibrillation (p-value: 0.05), the mean age was 41.78 ± 8.4 (p-value: 0.96), Wilkins score of 8.7 ± 1.0 (p-value: 0.03), valve thickness score of 2.2 ± 0.45 (p-value: 0.01), valve calcification score of 2.3 ± 0.45 (p-value:0.02), LVEF of 59 ± 10 (p-value:0.02), MVA of 0.66 ± 0.19/0.67 ± 0.19 (PHT/PLN) and an SPAP of 68.68 ± 21.75 (p-value:0.06).
Conclusion: PTMC for mitral stenosis in patients with moderate mitral regurgitation can still be done with favorable outcome provided that the patient is in sinus rhythm, the Wilkins Score is < 9, with scattered calcifications only up to the leaflet margins, minimal valve thickness, LVEF of > 60% and with a mild to moderate Pulmonary Hypertension.