FACTORS RESPONSIBLE FOR INSIGNIFICANT DECREASE IN PULMONARY ARTERY PRESSURE IMMEDIATELY AFTER PER CUTANEOUS TRANS-MITRAL COMMISSUROTOMY IN PATIENTS OF RHEUMATIC MITRAL STENOSIS
Main Article Content
Abstract
OBJECTIVES: To determine the factors responsible for insignificant decrease in pulmonary artery pressure immediately after percutaneous trans-mitral commissurotomy (PTMC) in patients of rheumatic mitral stenosis.
METHODS: This cross-sectional study was conducted on patients undergoing PTMC at Cardiology Unit, Lady Reading Hospital, Peshawar, Pakistan from 11th February, 2016 to 28th February, 2018. Pulmonary artery pressure (PAP) was noted before and after PTMC through echocardiography. Data was analyzed with SPSS Version 20.0, categorical and continuous variables were described as frequencies/percentages and mean±SD respectively. Odds Ratio was determined for factors negatively affecting the fall in PAP.
RESULTS: Out of 159 patients, 108 (67.9%) were females. Mean age was 25.38±10.67 years. PAP was insignificantly decreased in patients >30 years (p>0.05), symptoms for >5 years (p>0.05), left atrium diameter >4.5cm (p>0.05), atrial fibrillation (p>0.05), right ventricle diameter >2.5cm (p>0.05) and NYHA IV dyspnea (p>0.05). Odds Ratio for failure of significant decrease in PAP immediately post-PTMC was 1.68 for age more than 30 years, 1.10 for symptoms more than 5 years, 3.73 for LA diameter more than 4.5 cm, 2.31 for RV diameter more than 2.5 cm , 2.32 for history of atrial fibrillation and 6.71 for NYHA IV dyspnea.
CONCLUSION: Factors which negatively affect the immediate fall in PAP post-PTMC are age >30years, duration of symptoms >5years, LA diameter >4.5cm, history of atrial fibrillation, RV diameter >2.5cm and NYHA IV dyspnea and hence are the poor predictors of successful PTMC while NYHA IV dyspnea has highest Odds for insignificant decrease.
Article Details
Work published in KMUJ is licensed under a
Creative Commons Attribution 4.0 License
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
References
Zühlke L, Engel ME, Karthikeyan G, Rangarajan S, Mackie P, Cupido B, et al. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study). Eur Heart J 2014 Nov 26;36(18):1115-22. DOI: 10.1093/eurheartj/ehu449
Marcus RH, Sareli P, Pocock WA, Barlow JB. The spectrum of severe rheumatic mitral valve disease in a developing country: correlations among clinical presentation, surgical pathologic findings, and hemodynamic sequelae. Ann Intern Med 1994 Feb 1;120(3):177-83. DOI: 10.7326/0003-4819-120-3-199402010-00001
Celermajer DS, Chow CK, Marijon E, Anstey NM, Woo KS. Cardiovascular disease in the developing world: prevalences, patterns, and the potential of early disease detection. J Am Coll Cardiol 2012 Oct 2;60(14):1207-16. DOI: 10.1016/j.jacc.2012.03.074
Chandrashekhar Y, Westaby S, Narula J. Mitral stenosis. The Lancet 2009 Oct 10;374(9697):1271-83. DOI: 10.1016/S0140-6736(09)60994-6
Zaman KS, Saghir T, Jan D, Masood T, Tasneem H, Faruqui A. Percutaneous metallic mitral commissurotomy at NICVD. Pak Heart J 2012 May 14;34(1-4).
Bonow RO, Carabello BA, Chatterjee K, De Leon AC, Faxon DP, Freed MD, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 2006 Aug 1;48(3):e1-48. DOI: 10.1016/j.jacc.2006.05.021
Nunes MC, Tan TC, Elmariah S, do Lago R, Margey R, Cruz-Gonzalez I, et al. The echo score revisited: Impact of incorporating commissural morphology and leaflet displacement to the prediction of outcome for patients undergoing percutaneous mitral valvuloplasty. Circulation 2014 Feb 25;129(8):886-95. DOI: 10.1161/CIRCULATIONAHA.113.001252
Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol 2004 Feb 4;43(3):405-9. DOI: 10.1016/j.jacc.2003.09.036
Palacios IF, Sanchez PL, Harrell LC, Weyman AE, Block PC. Which patients benefit from percutaneous mitral balloon valvuloplasty?: Prevalvuloplasty and postvalvuloplasty variables that predict long-term outcome. Circulation 2002 Mar 26;105(12):1465-71. DOI: 10.1161/01.CIR.0000012143.27196.F4
Nunes MC, Nascimento BR, Lodi-Junqueira L, Tan TC, Athayde GR, Hung J. Update on percutaneous mitral commissurotomy. Heart 2016 Apr 1;102(7):500-7. DOI: 10.1136/heartjnl-2015-308091
Sarmiento RA, Blanco R, Gigena G, Lax J, Escudero AG, Blanco F, et al. Initial Results and Long-Term Follow-up of Percutaneous Mitral Valvuloplasty in Patients with Pulmonary Hypertension. Heart Lung Circ 2017 Jan 1;26(1):58-63. DOI: 10.1016/j.hlc.2016.04.026
Maoqin S, Guoxiang H, Zhiyuan S, Luxiang C, Houyuan H, Liangyi S, et al. The clinical and hemodynamic results of mitral balloon valvuloplasty for patients with mitral stenosis complicated by severe pulmonary hypertension. Eur J Intern Med 2005 Oct 1;16(6):413-8. DOI: 10.1016/j.ejim.2005.02.012
Iung B, Nicoud-Houel A, Fondard O, Akoudad H, Haghighat T, Brochet E, et al. Temporal trends in percutaneous mitral commissurotomy over a 15-year period. Eur Heart J 2004 Apr 1;25(8):701-7. DOI: 10.1016/j.ehj.2004.02.026
Chen CR, Cheng TO. Percutaneous balloon mitral valvuloplasty by the Inoue technique: a multicenter study of 4832 patients in China. Am Heart J 1995 Jun 1;129(6):1197-203. DOI: 10.1016/0002-8703(95)90404-2
Miura S, Arita T, Domei T, Yamaji K, Soga Y, Hyodo M, et al. Impact of preprocedural atrial fibrillation on immediate and long-term outcomes after successful percutaneous mitral valvuloplasty of significant mitral stenosis. Cardiovasc Interv Ther 2018 Jan 1;33(1):46-54. DOI: 10.1007/s12928-016-0434-9
Aman W, Hafizullah M, Gul AM, Faruqui RA. Optimizing outcomes in percutaneous transvenous mitral commissurotomy. Pak Heart J 2015 May 29;48(1):3-8.
Noor A, Saghir T, Zaman KS. Determinants of decrease in pulmonary hypertension following percutaneous transvenous mitral commissurotomy. J Coll Physicians Surg Pak 2009 Feb 1;19(2):81-5.
Inoue K, Owaki T, Nakamura T, Kitamura F, Miyamoto N. Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J Thorac Cardiovasc Surg 1984 Mar;87(3):394-402.
Vasan RS, Larson MG, Levy D, Evans JC, Benjamin EJ. Distribution and categorization of echocardiographic measurements in relation to reference limits: the Framingham Heart Study: formulation of a height-and sex-specific classification and its prospective validation. Circulation 1997 Sep 16;96(6):1863-73.
Kim KH, Kim YJ, Shin DH, Chang SA, Kim HK, Sohn DW, et al. Left atrial remodelling in patients with successful percutaneous mitral valvuloplasty: determinants and impact on long-term clinical outcome. Heart 2010 Jan 1:hrt-2009. DOI: 10.1136/hrt.2009.187088.