Ramachandran, P (2014) Echocardiographic Assessment of Pulmonary Artery Parameters Before and After Successful Percutaneous Transvenous mitral Commissurotomy in Rheumatic Mitral Stenosis. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION : The Most common cause of Mitral stenosis in developing countries like india is rheumatic fever,[19] with rheumatic manifestations present in almost 99% of mitral stenosis patients. 25% of RHD patients have isolated MS, and 40% have combined MS and MR. Involvement of multivalve is seen in 38% patients, in about 35% have aortic valve and the tricuspid valve in about 6%. Rarely pulmonic valve is affected. In acute rheumatic fever, there is inflammation and edema of the leaflets, with small fibrin-platelet thrombi along the leaflet contact zones. Subsequently patients develop scarring leads to the characteristic valve deformity, with obliteration of the normal leaflet architecture by fibrosis, neovascularization and increased collagen and tissue cellularity. Almost Two thirds patients with rheumatic MS are female. The onset of rheumatic fever and clinical evidence of MV obstruction is variable, ranging from a few years to more than 20 years.[ .[20] In developing countries- like india mitral stenosis progresses much more rapidly, because of more severe or repeated streptococcal infections, genetic influences, or economic conditions, and may lead to symptoms in the late teens and early twenties. Asymptomatic or minimally symptomatic patients 10 years Survival is >80% without treatment. Once patients develop symptoms (Functional Class III/IV) , survival without treatment predictably worsens and has been around at 0–15% over the subsequent 10 years. Mortality rate of patients with mitral stenosis without treatment is attributable to progressive heart failure in 60– 70% of patients, systemic embolism in 20–30%, pulmonary embolism in 10%, and infection in 1–5%. Initial presentation of patients with mild and moderate mitral stenosis (MVO 1.5 to 2.0 cm2) may be due to exercise , fever, pregnancy, emotional upset or atrial fibrillation, especially with a rapid ventricular response which precipitate the symptoms. In these patients Percutaneous Transvenous mitral Commissurotomy helpful to avoid early surgery. AIMS AND OBJECTIVES : To analyze Pulmonary Artery Parameters before and after Successful PTMC, in Rheumatic Mitral Stenosis patients by Echocardiography. CONCLUSION : 1.PTMC is a safe and effective procedure in Rheumatic mitral stenosis. After successful PTMC, pulmonary artery hemodynamics such as PASP, Mean PAP,PADP, Pulmonary vascular resistance as well as Pulmonary artery diameter was significantly reduced with in 48 hrs. This is easily measured with simple non invasive echocardiographic assessment. 2.With significant reduction of Pulmonary artery pressure after PTMC the Pulmonary artery acceleration time was significantly increased. 3. If patient develop moderate MR following PTMC as a complication of procedure ,Pulmonary artery hemodynamic parameters were not significantly reduced with in immediate 48 hrs.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Echocardiographic Assessment ; Pulmonary Artery Parameters ; Percutaneous ; Transvenous mitral Commissurotomy ; Rheumatic Mitral Stenosis. |
| Subjects: | MEDICAL > Cardiology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 06 Jul 2017 00:10 |
| Last Modified: | 06 Jul 2017 09:46 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1049 |
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