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[Percutaneous transvenous mitral commissurotomy in managing rheumatic mitral stenosis]
H Ishihara1, Y Hamanaka, T Sueda
1First Department of Surgery, Hiroshima University School of Medicine.
Abstract:
From April 1987 to October 1989, 32 patients with mitral stenosis (MS) were treated, of whom percutaneous transvenous mitral commissurotomy (PTMC) was performed in 14. PTMC was indicated by the surgeons in 5 patients including 1) 2 patients who refused reoperation, 2) one with early gastric cancer, 3) one with severe hyperthyroidism and cardiac cachexia, and 4) one with acute renal failure and aortic stenosis. In the other 9 patients, PTMC was indicated by the cardiologists, because it is less invasive. Thirteen patients underwent open mitral commissurotomy (OMC) and 5 patients were treated with mitral valve replacement (MVR). PTMC group: Symptoms were alleviated in 10 of 14. The mitral valve areas (MVA) changed from 1.03 +/- 0.47 cm2 to 1.90 +/- 0.67 cm2 (p < 0.001), and the mean pressure gradient between the left atrium and left ventricle decreased from 10.2 +/- 3.6 mmHg to 4.9 +/- 1.7 mmHg (p < 0.001). No significant mitral valve regurgitation (MR) was induced by PTMC. OMC group: Symptomatic improvement was observed in all patients. The MVA changed from 1.54 +/- 0.46 cm2 to 3.06 +/- 1.34 cm2 (p < 0.001) and the mean left atrial pressures were reduced from 17.6 +/- 7.8 mmHg to 10.5 +/- 4.2 mmHg (p < 0.001). MVR group: There was one hospital death, and the other 4 patients were discharged with satisfactory results. It is concluded that although PTMC has been routinely performed for mild cases, this method is also very helpful in treating patients having various complications which impede open heart surgery.
Insights
Percutaneous transvenous mitral commissurotomy (PTMC) effectively treats mitral stenosis, even in patients with complications that prevent open-heart surgery. This less invasive procedure improves symptoms and valve function without causing significant mitral regurgitation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Context:
- Mitral stenosis (MS) poses significant challenges for patients, often requiring invasive surgical interventions.
- Traditional open mitral commissurotomy (OMC) and mitral valve replacement (MVR) have established roles but carry risks, especially for patients with comorbidities.
- Percutaneous transvenous mitral commissurotomy (PTMC) emerged as a less invasive alternative.
Purpose:
- To evaluate the efficacy and safety of percutaneous transvenous mitral commissurotomy (PTMC) in patients with mitral stenosis (MS).
- To compare PTMC outcomes with those of open mitral commissurotomy (OMC) and mitral valve replacement (MVR).
- To assess PTMC's utility in patients with complications precluding open-heart surgery.
Summary:
- PTMC was performed in 14 of 32 MS patients, including 5 with surgical contraindications (e.g., gastric cancer, hyperthyroidism, renal failure).
- In the PTMC group, symptoms improved in 10 patients, with significant increases in mitral valve area (MVA) and reductions in pressure gradients, without inducing mitral regurgitation.
- OMC (13 patients) and MVR (5 patients) also showed symptomatic improvement, though MVR had one hospital death.
Impact:
- PTMC demonstrates significant efficacy in improving mitral valve area and reducing pressure gradients in mitral stenosis patients.
- The study highlights PTMC as a valuable and less invasive treatment option, particularly for patients with complex comorbidities unsuitable for open-heart surgery.
- These findings support the expanded use of PTMC beyond mild cases to a broader spectrum of mitral stenosis patients.