RIGHT VENTRICULAR FAILURE IN SPITE OF SUCCESSFUL PERCUTANEOUS MITRAL COMMISSUROTOMY IN PATIENTS WITH SEVERE MITRAL STENOSIS

Abstract

Objective: To know the frequency of right ventricular failure inspite of successfulpercutaneous mitral commissurotomy (PTMC) for isolated severe mitralstenosis.

Methodology: This observational study was conducted from January 2011 toDecember 2014 in Cardiology Department of Lady Reading Hospital, Peshawar.Patients with severe isolated mitral stenosis after successful PTMC werefollowed for one year. Patients who develop symptoms of right ventricular failurewere subjected to detailed transthoracic echocardiogram (TTE) includingassessment of right ventricular function.

Results: A total of 307 patients with severe isolated mitral stenosis who hadsuccessful PTMC were studied. Females were 185(60.26%) and males were122(39.74%). Mean age was 26.44±7.26 years. TTE performed before PTMC2 showing mean mitral valve area 0.9cm ±0.24cm . TTE 24 hours after PTMCshowed mean left atrial diameter 4.68±3.1cm, mean mitral valve area2 1.67±0.71cm , mean mitral valve gradient 5.42±4.6 mm of Hg, mean rightventricular systolic pressure(RVSP) 43±18.41 mm of Hg. After follow up for oneyear, 27(8.79%) patients developed signs and symptoms of congestive heartfailure. Of these, 10(3.25%) patients were found to have right heart ventriculardysfunction with no previous echocardiographic documented right ventriculardysfunction. Their mean age was 37.21±6.26years, of them, 6(60%) weremales and 4(40%) females. Mean RVSP 24 hours post PTMC was63±10.21mm of Hg, mean LA diameter 5.18± 1.82cm and mean LVEF50.14%± 5.82.

Conclusion: Patients with severe mitral stenosis who were older and who hadhigher right ventricular systolic pressure were more prone to develop rightventricular failure in spite of successful PTMC.