OUTCOMES OF PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY IN RHEUMATIC MITRAL STENOSIS AT 1 YEAR FOLLOW-UP AT NATIONAL INSTITUTE OF CARDIOVASCULAR DISEASES

Abstract

Objectives: To evaluate one year clinical outcomes of percutaneous transvenous mitral commissurotomy (PTMC) in patients with rheumatic mitral stenosis, with particular emphasis on the need for redo PTMC and to determine frequency of mitral regurgitation, incidence of stroke, and symptom recurrence at 1 year follow up and assess the overall success and safety of PTMC at 1 year.

Study Design: Prospective cohort study.

Place and Duration of Study: National Institute of Cardiovascular Diseases, Karachi from 1^st January 2024 to 30^th September 2024.

Methodology: A total of 196 patients with rheumatic mitral stenosis undergoing PTMC were enrolled using consecutive sampling and followed for one year. Successful PTMC was defined as >50% increase in mitral valve area, no or mild mitral regurgitation (MR), and symptomatic improvement. Data were analyzed using descriptive statistics and inferential analyses. Wilcoxon signed-rank and Stuart-Maxwell tests were used to compare paired continuous and categorical variables, respectively. Exploratory univariate logistic regression analyses were performed to identify factors associated with redo PTMC and symptom recurrence.

Results: The mean age of patients was 38.36±10.93 years, with a female pre-eminence (75.5%). At one-year follow-up, redo PTMC was required in 22 (11.2%) patients. Mitral regurgitation occurred in 29 (14.8%) patients, stroke in 2 (1.0%), and symptom recurrence in 47 (24.0%) patients. Non-compliance with medications was significantly associated with both redo PTMC (OR 10.32, 95% CI 3.75-28.39; p<0.001) and symptom recurrence (OR 59.37, 95% CI 13.13-268.51; p<0.001).

Conclusion: Percutaneous transvenous mitral commissurotomy remains a reliable treatment for rheumatic mitral stenosis. However, the need for redo percutaneous transvenous mitral commissurotomy in a notable proportion of patients highlights the importance of long-term follow-up and careful patient selection.