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Adhikari CM, Malla R, Rajbhandari R, Shakya U, Sharma P, Shrestha N, Kc B, Limbu D, Kc MB. Percutaneous transvenous mitral commissurotomy in juvenile mitral stenosis. Cardiovasc Diagn Ther 2016; 6:20-4. [PMID: 26885488 DOI: 10.3978/j.issn.2223-3652.2015.12.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Percutaneous transvenous mitral commissurotomy (PTMC) is a valid alternative to surgical therapy in selected patients with mitral stenosis. Juvenile mitral stenosis (JMS) varies uniquely from adult rheumatic heart disease (RHD). We aimed to evaluate the efficacy of PTMC in JMS patients. METHODS It was a single centre, retrospective study conducted between July 2013 to June 2015 in Shahid Gangalal National Heart Centre, Kathmandu, Nepal. Medical records of all consecutive patients aged less than 21 years who underwent PTMC were included. Mitral valve area (MVA), left atrial pressure and mitral regurgitation (MR) were compared pre and post procedure. RESULTS During the study period 131 JMS patients underwent PTMC. Seventy (53.4%) were female and 61 (46.6%) were male. Among the 131 patients, 40 (30.5%) patients were below the age of 15 years. Patient age ranged between 9 to 20 years with the mean of 16.3±2.9 years. Electrocardiography (ECG) findings were normal sinus rhythm in 115 (87.7%) patients and atrial fibrillation in 16 (12.3%) patients. Left atrial size ranged from 2.9 to 6.1 cm with the mean of 4.5±0.6 cm. The mean MVA increased from 0.8±0.1 cm(2) to 1.6±0.2 following PTMC. Mean left atrial pressure decreased from their pre-PTMC state of 27.5±8.6 to 14.1±5.8 mmHg. Successful results were observed in 115 (87.7%) patients. Suboptimal MVA <1.5 cm(2) in 11 (8.4%) patients and post-procedure MR of more than moderate MR in 5 (3.8%) patients was the reason for unsuccessful PTMC. CONCLUSIONS PTMC in JMS is safe and effective.
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Affiliation(s)
- Chandra Mani Adhikari
- 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal
| | - Rabi Malla
- 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal
| | - Rajib Rajbhandari
- 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal
| | - Urmila Shakya
- 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal
| | - Poonam Sharma
- 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal
| | - Nagma Shrestha
- 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal
| | - Bishal Kc
- 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal
| | - Deepak Limbu
- 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal
| | - Man Bahadur Kc
- 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal
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Saxena A. Catheter interventions for mitral stenosis in children: results and perspectives. World J Pediatr Congenit Heart Surg 2015; 6:250-6. [PMID: 25870344 DOI: 10.1177/2150135114568785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stenosis of the mitral valve most often occurs as a result of chronic rheumatic heart disease, causing thickening and fibrosis of the mitral valve apparatus. Rheumatic heart disease continues to be a major public health problem in several developing countries and mitral stenosis is also common in these regions. According to the reports from India and Africa, the disease tends to follow a rapidly progressive course in children. The treatment of choice is balloon dilatation of the mitral valve. Echocardiography is indispensable for this procedure. Before planning the procedure, it is essential to assess the suitability of balloon dilatation. Echocardiography performed during the procedure helps to decide whether the size of the balloon needs to be increased in case of inadequate relief of stenosis. Most published series have reported an immediate success rate of over 90% with balloon dilatation in children and young adults. With an increase in mitral valve area and improvement in functional class, the left atrial pressure and the transmitral gradients fall. These gratifying results are also reported from very young children of less than 12 years of age. It is recommended to start with a smaller balloon size and increase its size in a stepwise fashion to minimize complications. The complications, seen in about 1% to 2% of cases, include development of significant mitral regurgitation and hemopericardium, secondary to cardiac chamber perforation. The long-term results indicate slightly higher restenosis rates in children than in adults. Most children with restenosis can undergo successful repeat dilatation.
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Affiliation(s)
- Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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