PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY IN PATIENTS WITH RHEUMATIC HEART DISEASE: A HOSPITAL-BASED RETROSPECTIVE STUDY: Received 2021-05-29; Accepted 2021-11-25; Published 2022-07-01

Mohd Al-Baqlish Mohd Firdaus; Kelvin Shenq Woei Siew; Muhammad Adil  Zainal Abidin; Mohd Ridzuan Mohd Said; Mohd Firdaus Hadi; Muhammad Imran  Abdul Hafidz; Muhammad Dzafir Ismail; Ramesh Singh  Arjan Singh; Wan Azman  Wan Ahmad

doi:10.22452/jummec.vol25no2.3

Authors

Mohd Al-Baqlish Mohd Firdaus Division of Cardiology, Department of Internal Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
Kelvin Shenq Woei Siew Division of Cardiology, Department of Internal Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
Muhammad Adil Zainal Abidin Department of Community Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, Pahang, Malaysia
Mohd Ridzuan Mohd Said Department of Internal Medicine, Kulliyyah of Medicine International Islamic University Malaysia, Pahang, Malaysia
Mohd Firdaus Hadi Division of Cardiology, Department of Internal Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
Muhammad Imran Abdul Hafidz Division of Cardiology, Department of Internal Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
Muhammad Dzafir Ismail Division of Cardiology, Department of Internal Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
Ramesh Singh Arjan Singh Division of Cardiology, Department of Internal Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
Wan Azman Wan Ahmad Division of Cardiology, Department of Internal Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia

DOI:

https://doi.org/10.22452/jummec.vol25no2.3

Keywords:

Mitral stenosis, Mitral valve, Percutaneous Transvenous Mitral Commissurotomy, PTMC, Interventional cardiology

Abstract

Background: Percutaneous Transvenous Mitral Commissurotomy (PTMC) is a procedure of choice for the treatment of severe mitral stenosis. We aimed to describe our experiences on management of rheumatic heart disease with PTMC in Malaysia.

Methods: Patients who underwent PTMC were traced through the electronic medical record of University Malaya Medical Centre. The patients detailed echocardiogram parameter pre-procedure, post-procedure and outcome were documented. Statistical analysis was performed using SPSS version on 18 for windows.

Results: 11 patients were treated with PTMC in our centre with 90.9% (n=10) success rate. Subjects underwent PTMC were statistically significant associated with improved echocardiogram parameters as following: increase in mitral valve size (p=0.0058) from 0.89 ± 0.2 cm2 (pre) to 1.4 ± 0.4 cm2 (post); reduction in mean pressure gradient across mitral valve (p=0.0283) from 11.5 ± 4.9 mmHg (pre) to 6.9 ± 3.5 mmHg (post); and reduction (p=0.0019) in elevated pulmonary artery systolic pressure from 65.7 ± 21.4 mmHg (pre) to 45.6 ± 10.0 mmHg (post). More than half (62.5%, n=5) of the subjects with favourable Wilkin score 8 or less achieved good outcome defined as post-PTMC mitral valve size ≥ 1.5 cm2 . All subjects with unfavourable Wilkin score of more than 8 only achieved sub-optimal post-PTMC mitral valve size ≤ 1.5 cm2 .

Conclusion: Given the minimally invasive nature of PTMC with comparable excellent haemodynamic outcome to invasive vascular repair, PTMC should be the recommended first line therapy in mitral valve stenosis.