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Title: Reduction in pulmonary artery pressures on right heart cath after percutaneous transmitral commissurotomy.
Authors: Naeem Hameed, Shahid Abbas
Journal: The Professional Medical Journal (TPMJ)
Publisher: Independent Medical College, Faisalabad- Pakistan
Country: Pakistan
Year: 2023
Volume: 30
Issue: 3
Language: English
DOI: 10.29309/TPMJ/2023.30.03.7384
Keywords: INNOUE BalloonPercutaneous Mitral CommissurotomyTransthoracic EchoTransesophageal Echo
Objectives: To find out the reduction in pulmonary artery pressures on right heart Cath after percutaneous trans mitral commissurotomy. Study Design: Cross-sectional Observational study. Setting: Catheterization Lab Faisalabad Institute of Cardiology, Faisalabad. Period: April 2022 till October 2022. Material & Methods: After approval from hospital ethical committee 67 patients of severe mitral stenosis having pliable valve suitable for PTMC on TTE followed by TEE to exclude its contraindications and then finalized for PTMC procedure were enrolled in study after informed consent. PTMC was performed through femoral route using INNOUE balloon. Pre PTMC and post PTMC Right ventricle pressures were measured on table in cath lab. Results: Mean age was 33.8 ± 8.4 with 28.4% (n=19) were male, 71.6% (n=48) were females. 79 % patients had NYHA III symptoms of dyspnea. Mean LA diameter was 50.4mm and mean MVA was 1.02 cm2. 65.7% patients had A.fib before PTMC. Others were in sinus rhythm. Majority of patients had severe pulmonary hypertension before PTMC which had significant reduction (mean 23mmHg) in catheterization lab 10 minutes after PTMC procedure. Conclusion: PTMC is quite effective procedure with significant reduction of not only LA pressure but also of right ventricle indicating its effectiveness from the day of procedure.
To determine the reduction in pulmonary artery pressures measured by right heart catheterization following percutaneous transmitral commissurotomy (PTMC).
A cross-sectional observational study was conducted at the Catheterization Lab, Faisalabad Institute of Cardiology, from April 2022 to October 2022. 67 patients with severe mitral stenosis and pliable valves suitable for PTMC, confirmed by TTE and TEE, were enrolled after informed consent. PTMC was performed using the INNOUE balloon via the femoral route. Right ventricle pressures were measured immediately before and 10 minutes after the PTMC procedure. Data was analyzed using SPSS version 25.0.
graph TD;
A[Patient Selection Severe Mitral Stenosis, Pliable Valve] --> B[Pre-PTMC AssessmentTTE, TEE];
B --> C[Informed Consent];
C --> D[PTMC Procedure INNOUE Balloon, Femoral Route];
D --> E[Measure Right Ventricle Pressures Pre-PTMC];
D --> F[Measure Right Ventricle Pressures Post-PTMC];
E --> G[Data Analysis SPSS];
F --> G;
G --> H[Conclusion on PAP Reduction];
The study suggests that PTMC is an effective procedure for reducing pulmonary artery pressures, indicating immediate effectiveness in improving symptoms. The observed reduction in pulmonary artery pressure was more pronounced in patients with sinus rhythm, smaller left atrial size, and shorter symptom duration. The authors note that while previous studies have assessed pressure reduction using echocardiography at later time points, this study focused on immediate post-procedure invasive measurements.
A significant reduction in pulmonary artery pressures was observed immediately after PTMC, with a mean reduction of 23 mmHg (approximately 37%). The mean Mitral Valve Area (MVA) improved from 1.02 cm² to 1.96 cm².
Percutaneous transmitral commissurotomy (PTMC) is an effective procedure that leads to a significant reduction in pulmonary artery pressures, suggesting immediate clinical benefit from the day of the procedure.
1. Study Period: The study was conducted over a six-month period from April 2022 till October 2022. (Confirmed in text)
2. Number of Patients: 67 patients with severe mitral stenosis were enrolled in the study. (Confirmed in text)
3. Mean Age: The mean age of the patients was 33.8 ± 8.4 years. (Confirmed in text)
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