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Percutaneous transvenous mitral commissurotomy in mitral stenosis and left atrial appendage clot patients in special

Rajib Rajbhandari1, Rabi Malla1, Arun Maskey1

  • 1Shahid Gangalal National Heart Centre, Kathmandu, Nepal.

Indian Heart Journal
|December 10, 2016
PubMed

Insights

Percutaneous transvenous mitral commissurotomy is safe for mitral stenosis patients with left atrial appendage clot in urgent situations. This procedure offers an acceptable solution, improving outcomes without immediate complications.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Mitral stenosis is a condition often treated with percutaneous transvenous mitral commissurotomy (PTMC).
  • Left atrial appendage (LAA) clot is a common complication that prevents patients from undergoing PTMC.
  • Urgent intervention is sometimes necessary for patients with mitral stenosis and LAA clot who cannot receive anticoagulation.

Purpose of the Study:

  • To evaluate the feasibility and safety of PTMC in patients with mitral stenosis and LAA clot requiring urgent intervention.
  • To assess the procedural success and immediate outcomes in this specific patient cohort.

Main Methods:

  • Twenty patients with mitral stenosis (mitral valve area <1.5cm²), significant dyspnea, LAA clot, and urgent intervention needs were selected.
  • The study was conducted between January 2011 and December 2013 at Shahid Gangalal National Heart Centre, Kathmandu.
  • Informed consent and ethical approval were obtained prior to the procedure.

Main Results:

  • PTMC successfully increased the mean mitral valve area from 0.90cm² to 1.5cm² (p=0.02).
  • Mean left atrial pressure decreased from 20mmHg to 10mmHg, with subjective improvement reported in all patients.
  • No mortality, neurological complications, or need for emergency surgery occurred during the hospital stay or one-week follow-up.

Conclusions:

  • PTMC is a safe and feasible procedure for selected mitral stenosis patients with LAA clot in urgent situations.
  • The procedure yields acceptable immediate results when performed by experienced clinicians.
  • This approach provides a viable treatment option for patients who cannot undergo standard anticoagulation therapy.
Abstract

Keywords:
Left atrial appendage clotMitral stenosisPTMC

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