Clinical and Echocardiographic Follow-up after Successful Percutaneous Transvenous Mitral Commissurotomy

Background The objective of the study was to determine the long-term outcomes, including mitral restenosis and regurgitation, after successful percutaneous transvenous mitral commissurotomy (PTMC). Methods This cross-sectional prospective study was conducted at the cardiology department of Lady Reading Hospital, Peshawar, Pakistan, from January 2007 to December 2009. A total of 84 patients were followed up for a period of 96 months. Pre and post percutaneous transvenous mitral commissurotomy echocardiography was done on the mitral valve area (MVA) using two-dimensional (2D) and color doppler echocardiography. Patients who had successful PTMC were followed up for MVA loss, mitral regurgitation (MR), and cardiac death. SPSS Software (IBM SPSS Statistics for Windows, Version 22.0, Armonk, NY: IBM Corp.; 2013) was used for data analysis. Results Of the 84 patients, 21 were male, and 63 were females. The mean age was 35 ± 11 years. After PTMC, the mean valve two-dimensional area increased from 0.84 ± 0.13 to 1.83 ± 0.49 cm(2) (p value <0.001). MR was mild in 49 patients (62.8%), moderate in 27 patients (34.6%), and severe in two patients (2.6%). Good results were achieved in 60 (71.4%). Patients with good results were younger (24 ± 4), and had a relatively lower Wilkin's score, with a mean value of (8.4 ± 2.8). Follow-up events were death in six patients, mitral valve replacement (MVR) in 10 patients, and restenosis in seven patients. The Kaplan-Meier curve was used for the follow-up end points. Patient who required PTMC for mitral restenosis survived for a longer time than those requiring MVR, and those who had cardiac death due to severe pulmonary hypertension or heart failure. Conclusion Patients who had favorable Wilkin’s score and underwent PTMC for severe symptomatic mitral stenosis had better event-free survival in the long term follow-up.