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Rajan VKA, Chandran S, Kaskar A, Rao R, Mehra S. Surgical rescue mitral valve procedure post percutaneous transluminal mitral commissurotomy-a single-center observational study. Indian J Thorac Cardiovasc Surg 2024; 40:327-331. [PMID: 38681723 PMCID: PMC11045702 DOI: 10.1007/s12055-023-01654-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 05/01/2024] Open
Abstract
Percutaneous transluminal mitral commissurotomy (PTMC) has become the standard of care for severe mitral stenosis with favorable anatomy. Although the complications have reduced over the years, the need for emergency surgical rescue persists. This study evaluates the outcomes of surgical rescue performed within 24 h of undergoing PTMC from 1 January 2013 to 31 December 2019. Out of 2259 PTMC patients, 22 patients (< 1%) required rescue mitral valve surgery. Out of 22 patients, 17 patients (77.27%) developed mitral regurgitation; five patients (22.7%) had cardiac tamponade. Mitral valve replacement was performed in 20 patients (90.9%), while two patients (9.1%) underwent mitral valve repair. Cardiac tamponade was secondary to injury of the left atrium (9.1%), left ventricle (4.5%), and right ventricle (9.1%). Concomitant tricuspid valve repair was done in three patients (13.6%). Intraoperatively, anterior mitral leaflet tear was seen in 68.2% while posterior mitral leaflet tear was noted in 9.1%. Postoperatively, three patients (13.6%) required prolonged ventilation, incidence of stroke was 4.5% (n = 1), and in-hospital mortality was 4.5% (n = 1). Intra-aortic balloon pump was used in three patients (13.6%), preoperatively. We conclude that post-PTMC complications are rare, but they require urgent surgical intervention.
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Affiliation(s)
- Venkatesa Kumar Anakaputhur Rajan
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore, Karnataka 560099 India
| | - Suganya Chandran
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore, Karnataka 560099 India
| | - Ameya Kaskar
- Department of Cardiothoracic Surgery, NH SRCC Children’s Hospital, 1-1A, Keshavrao Khadye Marg, Haji Ali Government Colony, Mahalakshmi, Mumbai, Maharashtra 400034 India
| | - Rahul Rao
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore, Karnataka 560099 India
| | - Siddhant Mehra
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore, Karnataka 560099 India
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Yadav S, Shah S, Gajurel RM, Poudel CM, Ghimire R, Shah N. A study of Clinical Profile and in Hospital Outcomes of patients undergoing Percutaneous Transvenous Mitral Commissurotomy at a Tertiary Care Center of Nepal. Ann Med Surg (Lond) 2022; 84:104867. [PMID: 36536708 PMCID: PMC9758362 DOI: 10.1016/j.amsu.2022.104867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/26/2022] [Accepted: 10/30/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Rheumatic heart disease (RHD), is a common cause of mitral stenosis (MS) in developing nations. As per current recommendation, Percutaneous Transvenous Mitral Commissurotomy (PTMC) is advised as a Class IA (I-Class Of Recommendation, COR; A-Level Of Evidence, LOE) indication in patients with symptomatic severe mitral stenosis. We aim to examine the clinical profile and in-hospital results of PTMC for mitral stenosis. Methods A cross-sectional retrospective study was conducted at Manmohan Cardiothoracic Vascular and Transplant Center from April 2020 to May 2022. A structured questionnaire was used to collect the data and ethical approval for conducting the study was taken from the Institutional Review Committee (IRC) of Institute of Medicine (IOM). The data was collected in Microsoft Excel (Ver. 2013). For statistical analysis, SPSS 21 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) Association was measured using a parametric and non-parametric test (depending upon the distribution of data) and p value < 0.05 was considered significant. Results A total of 104 patients who met the inclusion criteria underwent PTMC during the study period. The mean age group of the patient was 41.7 ± 12.5 years, of which 23 (22.1%) were males and 81 (78.9%) were females. Mean mitral valve area prior to PTMC was 0.98 ± 0.19 mm2 that increased to 1.69 ± 0.19 mm2 after the procedure and it was statistically significant (p=<0.001). The post PTMC MVA varied with PTMC Wilkin's score with less than or equal to 8 having favorable outcomes. Conclusion Successful PTMC is highly influenced by the patients' increasing age, valve morphology (calcification, thickness, mobility), Left atrial dimensions, Pre PTMC mitral valve area, Degree of Baseline mitral regurgitation. Post procedure development of MR is usually well tolerated but rarely be severe enough requiring surgical valve replacement.
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Key Words
- AF, atrial fibrillation
- BMV, balloon mitral valvotomy
- CMC, closed mitral commissurotomy
- LA, left atrium
- LAP, left atrial pressure
- LVEF, Left ventricular ejection fraction
- LVSD, Left ventricle systolic dysfunction
- MI, Myocardial Infarction
- MS, mitral stenosis
- MVA, mitral valve area
- MVR, mitral valve replacement
- Mitral regurgitation
- Mitral stenosis
- Mitral valve area
- NSR, normal sinus rhythm
- NYHA, New York Heart Association
- Nepal
- OMC, open mitral commissurotomy
- Outcomes
- PA, pulmonary artery
- PASP, pulmonary artery systolic pressure
- PTMC
- PTMC, percutaneous transvenous mitral commissurotomy
- RHD, rheumatic heart disease
- TTE TEE, Transthoracic Echocardiography Transesophageal Echo
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Affiliation(s)
- Sutap Yadav
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj, Nepal
| | - Sangam Shah
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | - Ratna Mani Gajurel
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj, Nepal
| | - Chandra Mani Poudel
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj, Nepal
| | - Roshan Ghimire
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj, Nepal
| | - Nischal Shah
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj, Nepal
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Manjunath C, Khan AA, Dangas GD, Kaul U. Balloon Mitral Valvuloplasty. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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4
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Passos LSA, Becker-Greene D, Braulio R, Le TD, Gelape CL, de Almeida LFR, Rocha DPA, Gomes CAP, Esteves WAM, Passaglia LG, Dal-Bianco JP, Levine RA, Aikawa M, Hung J, Dutra WO, Nunes MCP, Aikawa E. Proinflammatory Matrix Metalloproteinase-1 Associates With Mitral Valve Leaflet Disruption Following Percutaneous Mitral Valvuloplasty. Front Cardiovasc Med 2022; 8:804111. [PMID: 35127864 PMCID: PMC8811173 DOI: 10.3389/fcvm.2021.804111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022] Open
Abstract
Mitral regurgitation (MR) is a major complication of the percutaneous mitral valvuloplasty (PMV). Despite high technical expertise and cumulative experience with the procedure, the incidence rate of severe MR has not decreased. Although some of MR can be anticipated by echocardiographic analysis; leaflet tearing, which leads to the most dreaded type of MR, remains unpredictable. Irregular valvular collagen remodeling is likely to compromise tissue architecture and increase the tearing risk during PMV balloon inflation. In this study, we evaluated histological and molecular characteristics of excised mitral valves from patients with rheumatic mitral stenosis (MS) who underwent emergency surgery after PMV due to severe MR caused by leaflet tear. Those findings were compared with patients who underwent elective mitral valve replacement surgery owing to severe MS, in whom PMV was not indicated. In vitro assay using peripheral blood mononuclear cells was performed to better understand the impact of the cellular and molecular alterations identified in leaflet tear mitral valve specimens. Our analysis showed that focal infiltration of inflammatory cells contributes to accumulation of MMP-1 and IFN-γ in valve leaflets. Moreover, we showed that IFN-γ increase the expression of MMP-1 in CD14+ cells (monocytes) in vitro. Thus, inflammatory cells contribute to unevenly remodel collagen resulting in variable thickening causing abnormalities in leaflet architecture making them more susceptible to laceration.
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Affiliation(s)
- Livia S. A. Passos
- Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Dakota Becker-Greene
- Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Renato Braulio
- School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Thanh-Dat Le
- Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Cláudio L. Gelape
- School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Luís Felipe R. de Almeida
- School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Divino Pedro A. Rocha
- School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Carlos Augusto P. Gomes
- School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - William A. M. Esteves
- School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Luiz G. Passaglia
- School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Jacob P. Dal-Bianco
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Robert A. Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Masanori Aikawa
- Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
- Center for Interdisciplinary Cardiovascular Sciences, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
- Department of Human Pathology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Judy Hung
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Walderez O. Dutra
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais, Belo Horizonte, Brazil
| | - Maria Carmo P. Nunes
- School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Elena Aikawa
- Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
- Center for Interdisciplinary Cardiovascular Sciences, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
- Department of Human Pathology, Sechenov First Moscow State Medical University, Moscow, Russia
- *Correspondence: Elena Aikawa
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Al-Hijji M, Ahmed A, Mohammed N, Rahhal A, Alzaeem H, Maaly C, Mousa T, Al Asmi S, Bitar B, Al-Kindi F, Arafa S, Al-Qahtani A. Percutaneous transvenous balloon mitral commissurotomy: A single-center experience. Heart Views 2022; 23:127-132. [DOI: 10.4103/heartviews.heartviews_78_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/08/2022] [Indexed: 11/07/2022] Open
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Mohan JC, Shukla M. Mitral Regurgitation Following Balloon Mitral Valvuloplasty: A New Twist on an Old Problem. JACC Cardiovasc Imaging 2020; 13:2527-2529. [PMID: 33129730 DOI: 10.1016/j.jcmg.2020.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Jagdish C Mohan
- Institute of Heart and Vascular Diseases, Jaipur Golden Hospital, Delhi, India.
| | - Madhu Shukla
- Institute of Heart & Vascular Diseases, Jaipur Golden Hospital, Delhi, India
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7
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Nunes MCP, Levine RA, Braulio R, Pascoal-Xavier MA, Elmariah S, Gomes NFA, Soares JR, Esteves WAM, Zeng X, Dal-Bianco JP, Passos LSA, Passaglia LG, Ribeiro VT, Gelape CL, Costa PHN, Lodi-Junqueira L, Dutra W, Tan TC, Aikawa E, Hung J. Mitral Regurgitation After Percutaneous Mitral Valvuloplasty: Insights Into Mechanisms and Impact on Clinical Outcomes. JACC Cardiovasc Imaging 2020; 13:2513-2526. [PMID: 32950446 DOI: 10.1016/j.jcmg.2020.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/13/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study was to assess the incidence, mechanisms, and outcomes of mitral regurgitation (MR) after percutaneous mitral valvuloplasty (PMV). BACKGROUND Significant MR continues to be a major complication of PMV, with a wide range in clinical presentation and prognosis. METHODS Consecutive patients with mitral stenosis undergoing PMV were prospectively enrolled. MR severity was evaluated by using quantitative echocardiographic criteria, and its mechanism was characterized by 3-dimensional transesophageal echocardiography, divided broadly into 4 categories based on the features contributing to the valve damage. B-type natriuretic peptide levels were obtained before and 24 h after the procedure. Endpoints estimated cardiovascular death or mitral valve (MV) replacement due to predominant MR. RESULTS A total of 344 patients, ages 45.1 ± 12.1 years, of whom 293 (85%) were women, were enrolled. Significant MR after PMV was found in 64 patients (18.6%). The most frequent mechanism of MR was commissural, which occurred in 22 (34.4%) patients, followed by commissural with posterior leaflet in 16 (25.0%), leaflets at central scallop or subvalvular damage in 15 (23.4%), and central MR in 11 (17.2%). During the mean follow-up period of 3 years (range 1 day to 10.6 years), 60 patients reached the endpoint. The event-free survival rates were similar among patients with mild or commissural MR, whereas patients with damaged central leaflet scallop or subvalvular apparatus had the worst outcome, with an event-free survival rate at 1 year of only 7%. Long-term outcome was predicted by net atrioventricular compliance (Cn) at baseline and post-procedural variables, including valve area, mean gradient, and magnitude of decrease in B-type natriuretic peptide levels, adjusted for the mechanism of MR. CONCLUSIONS Significant MR following PMV is a frequent event, mainly related to commissural splitting, with favorable clinical outcome. Parameters that express the relief of valve obstruction and the mechanism by which MR develops were predictors of long-term outcomes.
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Affiliation(s)
- Maria Carmo P Nunes
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Robert A Levine
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Renato Braulio
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcelo A Pascoal-Xavier
- Laboratory of Molecular Pathology, Department of Pathological Anatomy and Legal Medicine, School of Medicine of the Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sammy Elmariah
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nayana F A Gomes
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Laboratory of Molecular Pathology, Department of Pathological Anatomy and Legal Medicine, School of Medicine of the Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Juliana R Soares
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - William A M Esteves
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Xin Zeng
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob P Dal-Bianco
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Livia S A Passos
- Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, and National Institutes for Science and Technology, Belo Horizonte, Minas Gerais, Brazil; The Center for Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Luiz G Passaglia
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Victor T Ribeiro
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Cláudio L Gelape
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paulo H N Costa
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lucas Lodi-Junqueira
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Walderez Dutra
- Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, and National Institutes for Science and Technology, Belo Horizonte, Minas Gerais, Brazil
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, University of Western Sydney, New South Wales, Australia
| | - Elena Aikawa
- The Center for Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Judy Hung
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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8
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Balaji RM, Dhananjaya M, Thimmarayappa A. Troubleshooting for epileptiform activity during percutaneous transvenous mitral commisurotomy. Ann Card Anaesth 2019; 22:318-320. [PMID: 31274497 PMCID: PMC6639880 DOI: 10.4103/aca.aca_54_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Percutaneous transvenous mitral commisurotomy (PTMC) is a frequently used minimally invasive procedure for patients with symptomatic mitral stenosis. However, it is not without complications. Few complications which are distinctive to the procedure are thromboembolism, left-to-right shunts, mitral regurgitation, cardiac tamponade and complete heart block. We present the case of a 32-year-old female patient scheduled for a PTMC, who had multiple complications during the procedure. She developed cardiac tamponade for which pericardiocentesis and autotransfusion was done. Subsequently she exhibited epileptiform activity for which there was a diagnostic dilemma due to the presence of multiple confounding factors. However, she had a complete recovery without any residual sequelae at the time of discharge.
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Affiliation(s)
- Rohini Mayur Balaji
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Manasa Dhananjaya
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Ashwini Thimmarayappa
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
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9
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Pillai AA, Balasubramonian VR, Munuswamy H, Seenuvaslu S. Acute severe mitral regurgitation with cardiogenic shock following balloon mitral valvuloplasty: echocardiographic findings and outcomes following surgery. Cardiovasc Interv Ther 2018; 34:260-268. [DOI: 10.1007/s12928-018-0555-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/27/2018] [Indexed: 10/27/2022]
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Kale SB, Jagannathan R. Delayed complication of balloon mitral commisurrotomy. a rare case scenario. Indian J Thorac Cardiovasc Surg 2018; 34:417-419. [PMID: 33060906 DOI: 10.1007/s12055-017-0612-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/04/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022] Open
Abstract
The last two decades has seen percutaneous transmitral commissurotomy turn out to be the standard of care in most patients with symptomatic mitral stenosis with a large body of evidence reporting excellent outcome on the short- and long-term with low incidence of serious complications. Complications necessitating urgent surgery are rare and include acute severe mitral regurgitation from mitral valve tear and cardiac tamponade due to cardiac chamber perforation. We report a rare extracardiac bleeding complication of balloon valvotomy presenting a month after the procedure with severe symptoms and mediastinal shift warranting emergency redo sternotomy and mediastinal thrombectomy.
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Affiliation(s)
- Suresh Babu Kale
- Institute for Cardiac Treatment and Research, Southern Railway Headquarters Hospital, Perambur, Chennai, 600023 India.,Meenakshi Hospital, Trichy Road, Tanjore, Tamil Nadu 613005 India
| | - Raghavan Jagannathan
- Institute for Cardiac Treatment and Research, Southern Railway Headquarters Hospital, Perambur, Chennai, 600023 India
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11
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Sundaram S, Kaliappan T, Gopalan R, Palanimuthu R, Anandhan P, Joseph RM. Mechanism and Immediate Outcome of Significant Mitral Regurgitation Following Balloon Mitral Valvuloplasty with JOMIVA Balloon. J Clin Diagn Res 2017; 11:OC01-OC04. [PMID: 28511424 DOI: 10.7860/jcdr/2017/24202.9333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/09/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Balloon Mitral Valvuloplasty (BMV) with inoue balloon is the most common technique being followed worldwide. Over the wire BMV is a modified technique with Joseph Mitral Valvuloplasty (JOMIVA) balloon and is being followed in certain centres. We hypothesized that, the incidence and mechanism of Mitral Regurgitation (MR) is likely to be different from that of inoue balloon. AIM To assess the mechanism and immediate clinical outcome of significant MR following BMV with JOMIVA balloon retrospectively. MATERIALS AND METHODS We retrospectively analyzed the outcome of 48 patients who developed moderate to severe MR out of 249 patients who underwent BMV in our institute. We analyzed the echocardiographic and clinical parameters of these patients. RESULTS Nineteen (7.6%) patients developed severe MR and 29 (11.2%) patients developed moderate MR. Commisural separation resulting in MR was the most common cause which was contributing to 73.6 % and 85.7% of patients with moderate and severe MR respectively. Leaflet tear was the second most common cause which contributed to 15.7% and 14.2% of patients with severe and moderate MR respectively. Chordal rupture contributed to 10.5% of patients with severe MR. Six (31.6%) patients with severe MR developed worsening breathlessness among them one had to be referred for mitral valve replacement during index hospitalization and the rest could be managed medically. Patients with moderate MR remained asymptomatic and stable. CONCLUSION Severe MR following JOMIVA BMV results most commonly due to wide separation of commisures. JOMIVA balloon is less likely to cause damage to subvalvular structures than inoue balloon. Most patients who develop severe MR will not require emergency mitral valve replacement. Moderate MR is well tolerated clinically.
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Affiliation(s)
- Shanmuga Sundaram
- Associate Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Tamilarasu Kaliappan
- Associate Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Rajendiran Gopalan
- Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Ramasamy Palanimuthu
- Associate Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Premkrishna Anandhan
- Assistant Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Rinku Mary Joseph
- Clinical Pharmacist, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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12
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Manjunath C, Moorthy N, Kaul U. Balloon Mitral Valvuloplasty. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- C.N. Manjunath
- Sri Jayadeva Institute of Cardiovascular Sciences and Research; Bangalore India
| | - Nagaraja Moorthy
- Sri Jayadeva Institute of Cardiovascular Sciences and Research; Bangalore India
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13
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Figulla HR, Webb JG, Lauten A, Feldman T. The transcatheter valve technology pipeline for treatment of adult valvular heart disease. Eur Heart J 2016; 37:2226-39. [PMID: 27161617 DOI: 10.1093/eurheartj/ehw153] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 03/17/2016] [Indexed: 12/17/2022] Open
Abstract
The transcatheter valve technology pipeline has started as simple balloon valvuloplasty for the treatment of stenotic heart valves and evolved since the year 2000 to either repair or replace heart valves percutaneously with multiple devices. In this review, the present technology and its application are illuminated and a glimpse into the near future is dared from a physician's perspective.
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Affiliation(s)
- Hans R Figulla
- Universitätsklinikum Jena, Friedrich Schiller Universität Jena, Jena, Germany
| | - John G Webb
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Lauten
- Charité-Universitaetsmedizin Berlin, Department of Cardiology Berlin, Campus Benjamin Franklin, Germany
| | - Ted Feldman
- Cardiology Division, NorthShore University HealthSystem Evanston, Evanston, USA
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Sidhu NS, Kondethimmanahally Rangaiah SK, Ramesh D, Manjunath CN. Successful balloon mitral valvotomy in a rare coexistence of Ebstein's anomaly and rheumatic mitral stenosis. BMJ Case Rep 2016; 2016:bcr-2016-214674. [PMID: 27151140 DOI: 10.1136/bcr-2016-214674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Co-existence of Ebstein's anomaly of the tricuspid valve with rheumatic mitral stenosis is a very rare occurrence. We report the case of a young man who presented with progressive dyspnoea and was found to have rheumatic mitral stenosis with pulmonary hypertension and Ebstein's anomaly of the tricuspid valve. The patient underwent successful balloon mitral valvotomy resulting in marked improvement of symptoms.
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Affiliation(s)
- Navdeep Singh Sidhu
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, Karnataka, India
| | | | - Dwarikaprasad Ramesh
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, Karnataka, India
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15
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Chaturvedi V, Gupta MD, M P G. Subvalvular disease in patients undergoing balloon mitral valvotomy: a strong base is not always good. Indian Heart J 2015; 67:416-8. [PMID: 26432725 DOI: 10.1016/j.ihj.2015.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Vivek Chaturvedi
- Associate Professor of Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
| | - Mohit D Gupta
- Associate Professor of Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Girish M P
- Associate Professor of Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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16
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Li WW, Koolbergen DR, Bouma BJ, Hazekamp MG, de Mol BA, de Winter RJ. Cathether-based interventional strategies for cor triatriatum in the adult - feasibility study through a hybrid approach. BMC Cardiovasc Disord 2015; 15:68. [PMID: 26169911 PMCID: PMC4499942 DOI: 10.1186/s12872-015-0067-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 07/07/2015] [Indexed: 11/30/2022] Open
Abstract
Background Cor triatriatum is a rare congenital cardiac abnormality, consisting of an obstructing membrane between the pulmonary veins and the mitral valve in varying patterns. The entitiy can mimick the pathophysiology of mitral stenosis, necessitating surgical resection. Occasionally, percutaneous balloon dilatation of the membrane has been successfully performed. Case presentation We report two cases with cor triatriatum where intraoperative balloon dilatation of the membrane was attempted followed by surgical resection, to explore the feasibility of cathether-based interventional strategies for cor triatriatum. Conclusions Various anatomical variations exist of cor triatriatum, depending on the drainage of the pulmonary veins and the drainage of the proximal chamber in the right or left atrium. Only isolated forms of cor triatriatum where all pulmonary veins ultimately drain into the left atrium can be recommended for percutaneous strategies. In addition, several anatomical characteristics should be considered to predict technical success of cathether-based interventional strategies, such as the location of the membrane, the degree of pulmonary vein stenosis, the extent of calcification, and the presence of other (congenital) cardiovascular abnormalities. Furthermore, long-term efficacy of these strategies remains to be confirmed. As such, surgical treatment of cor triatriatum remains the mainstay of treatment in adult patients, especially when other cardiovascular anomalies are present which require surgical correction.
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Affiliation(s)
- Wilson W Li
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - David R Koolbergen
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Berto J Bouma
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Bas A de Mol
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Robbert J de Winter
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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17
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Figulla HR, Lauten A. [Interventional therapy of heart valve diseases: future perspectives]. Herz 2015; 40:215-23. [PMID: 25822420 DOI: 10.1007/s00059-015-4207-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Transcatheter procedures have been adopted as novel treatment strategy for patients with valvular heart disease, particularly for those who are inoperable or at high risk for surgical valve procedures. Significant technological advances have resulted in an improvement of devices for transcatheter aortic valve replacement (TAVI) with downsizing of crossing profiles, reduction in the rate of paravalvular leakage and conduction abnormalities as well as a lower short- and mid-term mortality and a higher patient acceptance. In the near future, TAVI may potentially develop as first-line treatment for the majority of patients with aortic valve disease. For patients with mitral and pulmonary stenosis, balloon valvuloplasty is effective and well established and should be preferred over valve replacement, last but not least also for economic reasons. For treatment of mitral regurgitation, several transcatheter devices aiming to restore or replace mitral valve function are currently under investigation. This review summarizes the current state of interventional treatment of valvular heart disease along with implications for the future.
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Affiliation(s)
- H R Figulla
- Klinik für Innere Medizin I, Universitätsklinikum Jena, Erlanger Allee 101, 07747, Jena, Deutschland,
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18
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Salehi N, Abdi S, Esmailzadeh M, Movasaghi N, Abadi MNA, Vakili-Zarch A. Right atrium clot formation following percutaneous transmitral valvuloplasty. Heart Surg Forum 2013; 16:E162-3. [PMID: 23803243 DOI: 10.1532/hsf98.20121140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This case report describes a rare complication of percutaneous transmitral commissurotomy (PTMC). A patient with severe mitral stenosis developed a clot in the right atrium after an unsuccessful PTMC procedure. Because of the high risk of thromboembolism, the patient underwent urgent surgery to remove the clot and to replace the mitral valve with a mechanical prosthesis.
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Affiliation(s)
- Negar Salehi
- Department of Cardiology, Rajaei Cardiovascular, Medical and Research Center, Tehran University of Medical Sciences, Tehran
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19
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Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Andrew Borger M, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Ž, Sechtem U, Anton Sirnes P, Tendera M, Torbicki A, Vahanian A, Windecker S, Popescu BA, Von Segesser L, Badano LP, Bunc M, Claeys MJ, Drinkovic N, Filippatos G, Habib G, Kappetein AP, Kassab R, Lip GY, Moat N, Nickenig G, Otto CM, Pepper J, Piazza N, Pieper PG, Rosenhek R, Shuka N, Schwammenthal E, Schwitter J, Tornos Mas P, Trindade PT, Walther T. Guíade práctica clínica sobre el tratamiento de las valvulopatías (versión 2012). Rev Esp Cardiol (Engl Ed) 2013. [DOI: 10.1016/j.recesp.2012.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Ž, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Popescu BA, Von Segesser L, Badano LP, Bunc M, Claeys MJ, Drinkovic N, Filippatos G, Habib G, Kappetein AP, Kassab R, Lip GY, Moat N, Nickenig G, Otto CM, Pepper J, Piazza N, Pieper PG, Rosenhek R, Shuka N, Schwammenthal E, Schwitter J, Mas PT, Trindade PT, Walther T. Guidelines on the management of valvular heart disease (version 2012). Eur J Cardiothorac Surg 2012; 42:S1-44. [DOI: 10.1093/ejcts/ezs455] [Citation(s) in RCA: 1024] [Impact Index Per Article: 85.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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21
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Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Ž, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Popescu BA, Von Segesser L, Badano LP, Bunc M, Claeys MJ, Drinkovic N, Filippatos G, Habib G, Kappetein AP, Kassab R, Lip GY, Moat N, Nickenig G, Otto CM, Pepper J, Piazza N, Pieper PG, Rosenhek R, Shuka N, Schwammenthal E, Schwitter J, Mas PT, Trindade PT, Walther T. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012; 33:2451-96. [PMID: 22922415 DOI: 10.1093/eurheartj/ehs109] [Citation(s) in RCA: 2622] [Impact Index Per Article: 218.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
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- Service de Cardiologie, Hospital Bichat AP-HP, 46 rue Henri Huchard, 75018 Paris, France.
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22
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Nanjappa MC, Ananthakrishna R, Setty SKH, Bhat P, Shankarappa RK, Panneerselvam A, Kamalapurkar G, Bhat SP, Rao VR. Acute severe mitral regurgitation following balloon mitral valvotomy: Echocardiographic features, operative findings, and outcome in 50 surgical cases. Catheter Cardiovasc Interv 2012; 81:603-8. [DOI: 10.1002/ccd.24417] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 03/12/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Manjunath C. Nanjappa
- Department of Cardiology; Sri Jayadeva Institute of Cardiovascular Sciences & Research; Bangalore; India
| | - Rajiv Ananthakrishna
- Department of Cardiology; Sri Jayadeva Institute of Cardiovascular Sciences & Research; Bangalore; India
| | - Srinivasa K. Hemanna Setty
- Department of Cardiology; Sri Jayadeva Institute of Cardiovascular Sciences & Research; Bangalore; India
| | - Prabhavathi Bhat
- Department of Cardiology; Sri Jayadeva Institute of Cardiovascular Sciences & Research; Bangalore; India
| | | | - Arunkumar Panneerselvam
- Department of Cardiology; Sri Jayadeva Institute of Cardiovascular Sciences & Research; Bangalore; India
| | - Giridhar Kamalapurkar
- Cardiothoracic and Vascular Surgery Department; Sri Jayadeva Institute of Cardiovascular Sciences and Research; Bangalore; India
| | - Seetharama P.S. Bhat
- Cardiothoracic and Vascular Surgery Department; Sri Jayadeva Institute of Cardiovascular Sciences and Research; Bangalore; India
| | - Venugopal Ram Rao
- Cardiothoracic and Vascular Surgery Department; Sri Jayadeva Institute of Cardiovascular Sciences and Research; Bangalore; India
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23
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Kirbas A, Gurer O, Ugurlucan M, Yildiz Y, Karabay BC, Isik O. Mitral regurgitation secondary to anterior leaflet rupture during percutaneous balloon valvuloplasty: case report. Heart Surg Forum 2010; 13:E328-9. [PMID: 20961835 DOI: 10.1532/hsf98.20101025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Rheumatoid heart disease and the mitral stenosis secondary to it in the long term are still important cardiovascular problems in developing countries. Percutaneous balloon mitral valvuloplasty is a valid treatment option with low complication rates for relieving the signs and symptoms of selected patients with mitral valve stenosis. In this report, we describe subacute mitral regurgitation secondary to anterior leaflet rupture following percutaneous balloon mitral valvuloplasty and the management strategy in a 54-year-old female patient. Such a complication is rare in experienced hands in the current era.
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Affiliation(s)
- Ahmet Kirbas
- Cardiovascular Surgery Clinic, Camlica Medicana Hospital, Istanbul
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24
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Iatrogenic Pericardial Effusion and Tamponade in the Percutaneous Intracardiac Intervention Era. JACC Cardiovasc Interv 2009; 2:705-17. [DOI: 10.1016/j.jcin.2009.04.019] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 04/03/2009] [Indexed: 11/20/2022]
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25
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LeVan P, Stevenson J, Develi N, Frey K. Cardiovascular Collapse After Femoral Venous Cannula Placement for Robotic-Assisted Mitral Valve Repair and Patent Foramen Ovale Closure. J Cardiothorac Vasc Anesth 2008; 22:590-1. [DOI: 10.1053/j.jvca.2007.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Indexed: 11/11/2022]
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26
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Choudhary SK, Talwar S, Venugopal P. Severe mitral regurgitation after percutaneous transmitral commissurotomy: underestimated subvalvular disease. J Thorac Cardiovasc Surg 2006; 131:927; author reply 927-8. [PMID: 16580462 DOI: 10.1016/j.jtcvs.2005.10.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Accepted: 10/11/2005] [Indexed: 11/30/2022]
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27
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Varma PK, Neema PK. Reply to the Editor. J Thorac Cardiovasc Surg 2006. [DOI: 10.1016/j.jtcvs.2005.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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