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Rapid snare sliding technique: An easy approach to difficult percutaneous transmitral commissurotomy.

ABSTRACT: Rheumatic heart disease (RHD) is a major health hazard in most developing countries as well as sporadically in developed economies with high prevalence rates. Mitral stenosis is among the important morbid valvular conditions accounting for 25% of RHD cases. Percutaneous transmitral commissurotomy (PTMC) using Inoue balloon is the standard treatment for severe mitral stenosis with favorable Wilkins score. In certain cases it is difficult to cross mitral valve (MV) either due to dilated left atrium (LA), low septal puncture, or severe mitral valvular and subvalvular stenosis leading to prolonged procedure time or failure of PTMC procedure. We describe a case of RHD with severe mitral stenosis and dilated LA where crossing MV was difficult and successful PTMC was performed using rapid snare sliding technique to cross the MV. .

SUBMITTER: Thakur D

PROVIDER: S-EPMC6149574 | biostudies-other | 2018 Apr

REPOSITORIES: biostudies-other

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Rapid snare sliding technique: An easy approach to difficult percutaneous transmitral commissurotomy.

Thakur Deepak D Chandra Yerramareddy Vijaya YV Muthukumaran Chinnasamy Sivaprakasam CS

Journal of cardiology cases 20180203 4

Rheumatic heart disease (RHD) is a major health hazard in most developing countries as well as sporadically in developed economies with high prevalence rates. Mitral stenosis is among the important morbid valvular conditions accounting for 25% of RHD cases. Percutaneous transmitral commissurotomy (PTMC) using Inoue balloon is the standard treatment for severe mitral stenosis with favorable Wilkins score. In certain cases it is difficult to cross mitral valve (MV) either due to dilated left atriu ...[more]

PMID: 30279870

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Project description:BackgroundMany previous studies have evaluated the impact of mitral valve (MV) deformity scores on the percutaneous transvenous mitral commissurotomy (PTMC) outcome in patients with mitral stenosis; however, the relationship between mitral annulus calcification (MAC) and the PTMC result has not yet been established. The current study aimed to investigate whether MAC could independently influence the immediate result of PTMC.MethodsOf all patients undergoing PTMC in our institution between April 2005 and November 2009, we included 87 patients (28.7%male, mean ± SD age = 42.8 ± 12.6 years) with rheumatic mitral stenosis who had additional data on the echocardiographic evaluation of MAC along with MV leaflets morphology. Echocardiographic assessments were repeated up to six weeks after PTMC to evaluate the immediate PTMC outcome. The frequency of the optimal PTMC result (secondary MV area > = 1.5 cm(2) with > = 25% increase and without final mitral regurgitation grade > 2) was compared between two groups of patients with MAC (n = 17) and those without MAC (n = 70).ResultsThe optimal result was obtained in 55 (63.2%) patients, whereas the result was suboptimal in 32 (36.8%) patients due to insufficient MV area increase in 31(96.9%) subjects and post-procedure mitral regurgitation grade > 2 in 1(3.1%). The rate of optimal PTMC results was less in patients with MAC in comparison to those without MAC (29.4% vs.71.4%). After adjustments for possible confounders such as age and leaflets morphological subcomponents (thickening, mobility, calcification, and subvalvular thickening), MAC remained a significant negative predictor of a suboptimal PTMC result (odds ratio = 0.154; 95%CI = 0.038-0.626, p value = 0.009) together with leaflet thickening (odds ratio = 0.214; 95%CI = 0.060-0.770, p value = 0.018).ConclusionsMAC appeared to independently influence the immediate result of PTMC; therefore, mitral annulus evaluation may be considered in the echocardiographic assessment of the mitral apparatus prior to PTMC.

Dataset Information

Rapid snare sliding technique: An easy approach to difficult percutaneous transmitral commissurotomy.

Publications

Rapid snare sliding technique: An easy approach to difficult percutaneous transmitral commissurotomy.

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