A Kazemi Khaledi ,
Volume 57, Issue 2 (5-1999)
Abstract
Background: Percutaneous Transeptal Mitral Commisurotomy (PTMC) has been used in treating mitral stenosis with variable success, its main complication being mitral incompetence. There is a need to define the subgroup of the patients who benefit mostly from the procedure. Methods: We studied 110 patients (age 17 to 60 years mean 33.2) with mitral stenosis. PTMC was performed though femoral vein. All patients underwent echocardiographic evaluation, both before and after the procedure. Clinical, hemodynamic and echocardiographic data were gathered and used to predict the outcome. Results: PTMC was successful in all 110 patients in alleviating the stenosis (mean transmitral gradient before procedure was 17.1 mmHg after procedure 4.4 mmHg). There was no mortality or major complication other than occurrence of mitral regurgitation in 9 cases. In this group only one patient subsequently needed a mitral valve replacement operation. The following parameters were found to have a significant correlation with the success rate of PTMC: lower age, shorter duration of illness, functional class III and IV, larger EF slope, smaller EPSS, smaller amplitude of valve motion, limitation of the posterior leaflet motion and negative history for open commisurotomy. The incidence of mitral regurgitation after procedure was found to be correlated with: atrial fibrillation rhythm before PTMC, lower age, longer duration of illness, more frequent relapse of rheumatic fever, functional class III and IV, less EF slope, limitation of the valve motion, larger left atrium, calcification of posterior leaflet and subvalvular extension. Conclusions: Balloon Mitral Valvuloplasty is an effective and relatively safe procedure in the management of the mitral stenosis. With the proper selection of the patients with the favorable outcome parameters, the rate of complication can be reduced.
Bagherzadeh Aa, Tavakoli T, Moshkani Farahani M,
Volume 69, Issue 5 (8-2011)
Abstract
Background: Cardiac resynchronization therapy (CRT) has proved as an efficient treatment in patients with end stage Heart failure. Previous studies showed the beneficial long term effects of CRT on the severity of mitral regurgitation (MR). The aim of this study was to evaluate acute effects of CRT on severity of MR.
Methods: This study was a double blind randomized trial performed from 1387 to 1388 in Imam Khomeini Hospital. Echocardiographic parameters including severity of MR were measured before and after CRT implantation with different echocardiographic methods.
Results: Patients had a significant improvement in severity of MR (14% Vs. 11% P<0/05), in increasing ejection fraction (18/04 Vs. 24/42 P<0/05) and in decreasing end systolic diameters (6/14 Vs. 5/98 P<0/05) and end diastolic diameters (7 Vs. 6/8 P<0/05) after CRT implantation. The reduction of MR was significantly correlated with the improvement of ejection fraction (P=0.07).
Conclusion: The mechanism of decreasing severity of MR is not yet truly understood and may be different in acute and chronic phases. Correction of left ventricular dyssynchrony might influence the improvement of MR severity. Also, synchronization of papillary muscle and increased transmitral pressure with more forceful mitral valve closure, decreases regurgitation fraction and volumes is proposed for these beneficial effects. If posterior papillary muscle is involved in dyssynchrony, the acute reduction of MR following CRT is expected but if the dyssynchrony is mainly at the lateral parts of left ventricle MR might be improved in longer durations.
