EFFICACY AND SAFETY OF PERCUTANEOUS TRANSVENOUS MITRAL COMMISUROTOMY (PTMC) PERFORMED THROUGH PATENT FORAMEN OVALE (PFO)

Abstract

Objective:The aim of this study was to assess efficacy and safety of PTMC in
patients with severe mitral stenosis (MS) perform through patent foramen ovale.
Methodology:All symptomatic patients with severe MS were included in the
study from January 1998 to December 2010, at Cardiology department, Lady
Reading Hospital, Peshawar. Transthoracic and trans-esophageal
echocardiogram was performed to exclude left atrial appendage/left atrial clot
and check the anatomy of interatrial septum. Severely calcified mitral valve and
severe mitral regurgitation were excluded. Patent foramen ovale was crossed in
majority of cases to reach left atrium. Stenosed mitral valve was dilated with
Inoue balloon.
Results: Total number of patients was 1818. Females were 74% (p<0.05). The
mean age was 26.51±7.82 years and mean Body Mass Index (BMI) was
2 19.05±1.2kg/m . The number of patients who had PTMC through PFO were
2 92.08%. Mean valve area was 0.9±0.19cm on 2D Echocardiography, which
2 increased to 1.82±0.17cm (p<0.05), mean mitral valve gradient decreased
from 18±4.04mmHg to 7±0.25mmHg (p<0.005) and mean right ventricular
systolic pressure decreased from 70±17.4mmHg to 48±13mmHg (32% drop)
(p<0.05) at 24hours after PTMC. Mean time of crossing interatrial septum via
PFO was 17±05minutes. Post PTMC severe MR in PFO group was 3.6% and
2.8% in inter atrial septum group (p=0.21). Pericardial effusion was noted in
0.11% patients in PFO group and 0.27% in interatrial septum group (p>0.05).

Conclusion: PTMC through patent foramen ovale (PFO) is a safe procedure, with
few complications.