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[First Lebanese series of percutaneous mitral commissurotomies]
Insights
Percutaneous mitral commissurotomy (PMC) is effective for treating mitral stenosis in Lebanon. This procedure significantly improves mitral valve area and reduces pressure gradients, offering a viable treatment option.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Mitral stenosis is a significant valvular heart disease.
- Percutaneous mitral commissurotomy (PMC) is an alternative to surgical intervention.
- This study presents the initial experience with PMC in Lebanon.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous mitral commissurotomy (PMC) in the first Lebanese series.
- To assess the procedural outcomes and hemodynamic improvements.
- To determine the suitability of PMC as a primary treatment for mitral stenosis in the region.
Main Methods:
- 11 patients with mitral stenosis underwent percutaneous mitral commissurotomy (PMC) using the Inoue balloon technique.
- Procedures involved stepwise balloon inflation with color Doppler echocardiography guidance.
- Pre- and post-procedure evaluations included transthoracic and transesophageal echocardiography to assess mitral valve area and gradients.
Main Results:
- Successful bicommissural or unicommissural opening was achieved in all patients.
- Mean mitral valve area increased from 1 cm² to 2.3 cm² post-procedure.
- Mean transmitral gradient decreased from 20 mmHg to 4 mmHg, with no significant mitral regurgitation.
Conclusions:
- Percutaneous mitral commissurotomy (PMC) is a safe and effective treatment for non-calcified or minimally calcified mitral stenosis.
- The procedure yields significant hemodynamic improvements and is a viable option for Lebanese patients.
- The Ministry of Health in Lebanon should consider covering PMC as a standard treatment modality.
Abstract:
From January 1993 to January 1994, we realized at Risk Hospital 11 percutaneous mitral commissurotomies (PMC). This first Lebanese series comprised 9 women and 2 men. The mean age was 36 y (18-73 y). Ten patients were en class III of the NYHA and one in class IV (pregnant woman on the end of the 7th month). The predilatation evaluation was done by transthoracic echocardiography for the just 2 patients and by transthoracic with transesophageal multiplane echocardiography for the 9 others. The mean gradient was at 20 mmHg (10-24 mmHg) and the mean mitral area at 1 cm2 (0.65-1.5 cm2). We used the Inoue balloon for all these procedures with a stepwise technique and a color echo-doppler control between inflations. We obtain bicommissural opening in 8 patients and unicommissural opening in 3 patients. The mean gradient post dilatation was at 4 mmHg (3-8 mmHg) and the mean mitral area at 2.3 cm2 (1.5-2.8 cm2). No mitral regurgitation > 2/4 was noted. After a general review, we concluded the PMC is at present the treatment of choice of non or discrete calcified mitral stenosis and this procedure has to be taken on charge by the Ministry of Health in Lebanon.