Clinical Outcome Analysis of Closed Mitral Commissurotomy and Percutaneous Transmitral Commissuratomy: A Comparative study

Ragavendran, R (2007) Clinical Outcome Analysis of Closed Mitral Commissurotomy and Percutaneous Transmitral Commissuratomy: A Comparative study. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: Rheumatic Heart disease continues to be a major cardiac problem in India, much of Asia, Latin America and Middle East caused by Group A _ haemolytic streptococcus. Although the prevalence of rheumatic disease among persons in developed nations, such as the US is steadily declining, the prevalence is higher in developing nations. In India, for example, the prevalence is approximately 100-150 cases per 100 000 population. Mitral stenosis is the predominant lesion in rheumatic heart disease. Without surgical relief of stenosis, the natural history of Mitral stenosis is poor. The 10 year survival rate for asymptomatic persons is approximately 80%. 10 year survival rate for patients with mild symptoms is approximately 60% & the 10 yr survival among patients who developed congestive cardiac failure is 15%. Various modalities of management for rheumatic Mitral stenosis has evolved since Brunton suggested surgical correction of Mitral stenosis in 1902. The options available are closed mitral Commissurotomy, open mitral valvotomy, percutaneous trans mitral commissurotomy (PTMC) and Mitral valve replacement. Each procedure has its own merits and demerits. A recent long term study showed no advantage for the open Verses the closed procedure. But PTMC offers certain distinct advantages over surgical commisurotomy. However, considering the cost of the procedure and the expertise needed for PTMC, this procedure may only complement and not replace the currently available surgical options. In developing countries where widespread use of Cardio Pulmonary Bypass is not always practical, closed mitral commissurotomy is a safe alternative to open mitral commissurotomy and balloon mitral commissurotomy in selected patients with minimal early risk and excellent long term results. AIM OF THE STUDY: 1. To study the epidemiology of Rheumatic mitral valve disease. 2. To evaluate the outcome after closed mitral commissurotomy in our institution. 3. To compare our results with various other reports in the literature. 4. To compare our results with the results of Percutaneous Trans mitral Commissurotomy in our institution. 5. To analyse the incidence of various complications following closed mitral commissurotomy. 6. To get supportive evidence for importance of closed mitral commissurotomy in developing countries like India. MATERIALS AND METHODS: Between Jan2006 to Dec2006, 412 patients with valvular heart disease were admitted in the department of CT Surgery, Govt. General Hospital, Chennai. Out of 412 patients, 392 patients were with isolated mitral valve disease. Among 392 patients, 260 patients, fulfilled the criteria for closed mitral commissurotomy which included 9 patients with mitral restenosis and 1 patient with pregnancy. Patients were selected for CMC based on echo cardio graphic findings. Patients with severe mitral stenosis and echo cardio graphic score of <8 (Wilkin’s score), raised Pulmonary Artery Systolic Pressure and patients with Atrial fibrillation are all included. Patients having echo score of >8, LA & LAA clot, moderate MR were excluded. After the operation patients were followed up for six months for haemodynamic stability. In all cases, the procedure was performed through a standard left antero-lateral thoracotomy and closed mitral commissurotomy was done through transventricular route using Tubbs dilator. During the same period, using the same criteria as for that of CMC, 72 patients underwent PTMC in our cardiology department using Inoue single balloon technique. Echocardiogram was taken at discharge and at 6th month, post operatively. CONCLUSION: 1. The Commonest cause for mitral stenosis is rheumatic. 2. Females are more commonly affected than males (70%). 3. Mitral valve is the commonly affected valve in the rheumatic valvular heart disease. 4. Most common age of presentation for surgery is in the 3rd decade of life. 5. Most patients presented with NYHA class III symptoms. 6. Overall incidence of atrial fibrillation is 21% and the incidence of atrial fibrillation increases with age. 7. Complications following CMC is very minimal and is comparable to any other results reported in literature. 8. PTMC provided somewhat lesser MVO and haemodynamics than CMC. 9. Though there was no major complications following PTMC, number of failed attempts were relatively high. 10. Considering the cost of the procedure, the expertise needed and case load, CMC is a safe alternative to OMV and PTMC in selected patients with minimal early risk and excellent long term outcome.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Clinical Outcome Analysis ; Closed Mitral Commissurotomy ; Percutaneous Transmitral Commissuratomy ; Comparative study.
Subjects: MEDICAL > Cardio Vascular and Thoracic Surgery
Depositing User: Kambaraman B
Date Deposited: 10 Nov 2017 17:09
Last Modified: 10 Nov 2017 17:09
URI: http://repository-tnmgrmu.ac.in/id/eprint/3876

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