Page 23 - Journal of Structural Heart Disease Volume 3, Issue 3

Meeting Abstracts
76
EXPERIENCE ON PERCUTANEOUS TRANSLUMINAL MITRAL COMMISURIOTOMY IN SHAHID GANGALAL NATIONAL HEART CENTRE, BANSBARI, KATHMANDU, NEPAL
Chandra Mani Adhikari
Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal
Rheumatic Heart Disease (RHD) is the most common acquired heart disease in children in developing countries. RHD continues to be an important public health problem in Nepal. Approximately 25% of patients with RHD have isolated mitral stenosis (MS), and an addi- tional 40% have combined MS and mitral regurgitation (MR). Based upon the nature and severity of MS, patients can be managed with medical management, percutaneous transluminal mitral commissur- otomy (PTMC) or surgery. Since 1984, PTMC has revolutionized the treatment of patients with symptomatic MS. It has established itself as the procedure of choice for symptomatic MS patients. PTMC is rec- ommended for symptomatic patients with severe MS (mitral valve area (MVA) ≤1.5 cm2) and favorable valve morphology in the absence of left atrial (LA) thrombus and or moderate-to-severe MR.
PTMC in Overall Patient at SGNHC: To serve the Nepalese patients with MS, PTMC service started in National heart centre in 2001. First PTMC in the centre was done on 14th April 2001. Till June 2016, 6023 PTMC were done in SGNHC. Government of Nepal provides free PTMC services to all the patients. In the rst study published to evaluate the safety and e cacy of PTMC, two hundred patients from January 2003 to July 2004 were studied. Seventy four percent of the patients were female. Age ranged from 10 years to 61 years with the mean age 29 years. Mean MVA increased from 0.9±0.1cm2 to 1.8±0.2cm2. Mean LA pressure decreased from 21 to 7 mmHg. There was no mortality during the hospital stay or within the rst month of the procedure. Two patients developed severe MR.
In another study, 1001 patients from March 2003 to March 2008 were studied. Seventy eight percent were female. Age ranged from 9 years to 68 years with mean age 31.2±12.4 years. MVA increased from 0.88±0.1cm2 to 1.67±0.2cm2. LA pressure decrease from 29.7 ± 8.6 to 12.8± 5.3 mmHg. Severe MR was noted in 2.1% patients. One had to undergo urgent mitral valve replacement (MVR) due to severe MR, two died of pulmonary edema due to severe MR. There were three deaths due to cardiac tamponade and one death in pregnant women who died due to abortion and septicemia.
In a recent prospective study, 262 patients who underwent PTMC during July 2013 to June 2014 were studied. Seventy four percent of the patients were female. Age ranged from 10 to 76 years with mean age of 33.2±12.5 years. Mean LA pressure decreased from 26.8 ± 8.9 mmHg to 15.6 ± 7.2 mmHg. MVA increased from 0.9 ± 0.17 cm2 to 1.6 ± 0.28 cm2. Moderate to severe MR was seen in 49(18.7%) patients after PTMC but none of them required emergency MVR. There was no mortality related to the procedure.
PTMC in Elderly: In a retrospective study in elderly (≥60years) patients, 49 patients underwent PTMC between March 2007 to March 2013 were studied. It accounts less than 2% of the total PTMC done during the study period. The MVA increased from 0.9±0.1 to 1.6±0.3 cm2 following PTMC. Mean LA pressure decreased from 25.4±6.6 to 12.9±4.5mmHg. Severe MR occurred in one patient. There were no other complications like death or pericardial e usion.
PTMC in Children: In a retrospective study performed from November 2009 to May 2013 to evaluate the safety and e cacy of PTMC in children. During the study period 2237 patients, among them 100 patients aged less than 15 years underwent PTMC procedure for severe MS. After PTMC, MVA increased from 0.7±0.1cm2 to 1.5±0.3 cm2 and mean LA pressure decreased from 29±7.9 mmHg to 13.9±6.2 mmHg.
PTMC in Juvenile Patients (Younger Than 20 Years Of Age): In a retro- spective study of PTMC in 131 juvenile patients who underwent elec- tive PTMC from July 2013 to June 2015 were studied. The mean MVA increased from 0.8±0.1 cm2 to 1.6±0.2 cm2 following PTMC. Mean LA pressure decreased from 27.5±8.6 to 14.1±5.8 mmHg. Post procedure severe MR was seen 3.8% patients. Among them one patient needed MVR after the PTMC, patient died after MVR.
PTMC in Pregnancy: A study was done among twenty two pregnant women from Jan 2003 to Dec 2007 to evaluate the safety and e cacy of PTMC with severe MS.PTMC was done during the 24.2±4.6 weeks of gestation. Mean age was 23±4.2 years and two patients were in AF. Fluoscopy time needed to complete the procedure was 7.5±4.8min. Procedure was successful in all patients. Mean MVA increased from 0.7±0.2cm2 to 1.8±0.2cm2. Mean LA pressure decreased from 28.1±4.3mmHg to 15.3±6.2mmHg.Twenty patient had a normal delivery whereas two underwent caesarean section. There was no maternal morbidity or mortality or intrauterine growth retardation.
Though there are multiple studies to study the safety and e ective- ness of PTMC in our patients we still don’t have any study about the long-term e ect of PTMC in our patients. We need a long-term study to evaluate the safety and e cacy of this simple procedure in near future.
BALLOON DILATATION OF PULMONARY ARTERY STENOSIS FOLLOWING ARTERIAL SWITCH OPERATION FOR COMPLETE TRANSPOSITION OF THE GREAT ARTERIES
Eloisa Victoria Claveria-Barrion, Jean Villareal, Juan Reganion
Philippine Heart Center, Manila, Philippines
History and Physical: This is a case of a neonate who consulted due to cyanosis. He was born to a 25 year old G2P1 mother via normal spontaneous delivery. He had unremarkable birth and maternal his- tory but was noted to have cyanosis on the 2nd day of life. He was brought to the Philippine Heart Center and was subsequently admit- ted. Physical examination reveals oxygen desaturation at 64% with a grade 3/6 continuous murmur on the left upper sternal border. 2D-echocardiography revealed CHD, D- Transposition of the Great Arteries with intact ventricular septum, Patent Ductus Arteriosus and Patent foramen Ovale. He underwent Arterial Switch Operation with PDA ligation and immediate improvement of the oxygen saturations was noted at 80 %. However, 2 months post-operatively, he pre- sented again with desaturations as low as 50%. Repeat 2-dechocardi- ography showed supravalvar pulmonic stenosis with a gradient of 93 mmHg across the stenotic area. He was referred to Pediatric Invasive Cardiology for Percutaneous Pulmonic Balloon Valvulotomy.
Physical examination revealed vital signs as follows: cardiac rate of 130s, respiratory rate of 42 cycles per minute with oxygen saturation
Journal of Structural Heart Disease, June 2017
Volume 3, Issue 3:73-95