Mid-term results of percutaneous transmitral commissurotomy (PTMC) in central iran

Abbas  Andishmand; Hossein  Montazer Ghaem; Somayeh  Fallahzadeh; Mojtaba  Andishmand; Hasan  Haghaninejad; Faezeh  Dehghani-Tafti; Mahdiah  Namayandah; Hossein  Nough

doi:10.18502/cbj.v4i1.16221

Abbas Andishmand Yazd Cardiovascular Research Center, Non- communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Hossein Montazer Ghaem Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
Somayeh Fallahzadeh Khatamolanbia Hospital, Abarkooh University of Medical Sciences, Yazd, Iran
Mojtaba Andishmand Yazd Cardiovascular Research Center, Non- communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Hasan Haghaninejad Yazd Cardiovascular Research Center, Non- communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Faezeh Dehghani-Tafti Yazd Cardiovascular Research Center, Non- communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Mahdiah Namayandah Yazd Cardiovascular Research Center, Non- communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Hossein Nough Yazd Cardiovascular Research Center, Non- communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

DOI: https://doi.org/10.18502/cbj.v4i1.16221

Keywords: Survival, Rheumatic fever, mitral valve stenosis, percutaneous trans-mitral commissurotomy

Abstract

Objectives: Percutaneous Trans-Mitral Commissurotomy (PTMC) is an effective non-surgical treatment in patients with severe rheumatic mitral valve stenosis. This study aimed to evaluate the mid-term results of this procedure in central Iran.

Methods: This retrospective study was performed on 101 patients with severe mitral valve stenosis who underwent successful PTMC from March 2011 to September 2018 in Afshar Hospital in Yazd. At follow-up, all patients underwent clinical examination, two-dimensional and color Doppler echocardiography, and events were recorded. Data were analyzed using SPSS software version 19.

Results: The mean age of the patients was 44.79± 11.72 years, and 83.3% were female. The mean follow-up time was 38.98 23.33 months (6-94 months).25.8% had AF rhythm, and 12% had previous PTMC or OMVC or CMVC. After percutaneous Trans-Mitral Commissurotomy, 97% of patients were in NYHA functional class I, II and the mitral valve area (MVA) increased from 0.92 ± 0.18 to 1.66± 0.29 cm2 (p<0.0001). Pulmonary artery systolic pressure decreased from 46.96± 18.56 mmHg to 38.43±14.02 mmHg (p<0.0001). The Mean mitral valve gradient decreased from 12.37± 3.99 mmHg to 4.79± 2.38 mmHg (p<0.0001). Restenosis rate and severe mitral regurgitation resulting in mitral valve replacement (MVR) were 10.9% and 2%, respectively. Two patients died because of intracranial hemorrhage (ICH). During the follow-up event, free survival was 82.2%. Multivariable analysis revealed that the predictors of shorter event-free survival were AF rhythm (HR; 4.5, 95%CI;1.59-12.9, P=0.005) and post PTMC higher NYHA functional class (HR;2.2, CI;1-4.8,p=0.049).

Conclusions: Mid-term results of percutaneous transmitral commissurotomy (PTMC) in central Iran are the same as in other parts of the world. This procedure is an effective and low-risk treatment for severe mitral valve stenosis.