TWENTY YEARS EXPERIENCE OF SUCCESSFUL PERCUTANEOUS TRANSMITRAL COMMISUROTOMY PERFORMED THROUGH PATENT FORAMEN OVALE

Abstract

Objective: To assess the efficacy and effectiveness of PTMC through patentforamen ovale in patients with symptomatic mitral stenosis.

Methodology: This cross sectional study included patients with symptomaticmitral stenosis from January 1995 to December 2016, at Lady Readng Hospital,Cardiology Department. All patients were subjected to detailed clinicalexamination. BLIs were performed. (TTE and TEE) wasperformed to exclude LA/LAA clot, to assess the calcification of mitral valve andcheck the anatomy of inter ventricular septum. Patients with severely calcifiedmitral valve and with +2 mitral regurgitation were excluded. PFO was crossed inmajority of cases to reach LA. Mitral valve stenosis was relieved with Inoueballoon.

Result: Total number of patients enrolled was 3751. Females were 76%. Themean age was 27.5± 7.2 years. Mean BMI was 19.8±2.1 kg/m . PTMC of92.08% patients was performed through PFO. Mean valve area was 0.9±0.21cm on 2D echocardiography, which was successfully dilated upto 1.82±0.17cm (p>0.05). Mitral valve gradient decreased from18 ± 4.08 mm of Hg to7.0 ± 0.25 mm of Hg (p< 0.005). Mean right ventricular systolic pressuredecreased from 70 ± 17.4 mm of Hg to 48 ± 13mm of Hg with 32% drop ofpressure at 24 hrs post PTMC (p<0.05). Post PTMC mitral regurgitation wasfound in 3.6% in PFO group and 2.8% in inter atrial septum group. Pericardialeffusion was found in 0.11% patients in PFO group and 0.27% in interatrialseptum group (p > 0.05). Abandonment rate of PTMC through PFO was quiteless 0.57% as compared to PTMC through septal puncture 2.69%.

Conclusion: PTMC through PFO is effective, safe and user friendly procedurewith fewer complication rates.

Key Words:Percutaneous transmitral commisurotomy, Patent foramen ovale,Transesophageal echocardiography, Transthoracic echocardiography, Leftatrium.222EchocardiographyPak Heart