Blood Pressure Monitoring: A noble method for stepwise decision making in percutaneous mitral valvuloplasty

摘要

Background : To find out if systolic blood pressure changes during percutaneous Mitral comissurotomy (PMC) could be a reliable guide to staged decision making and evaluate stop point. Method: 102 patients with moderate to severe mitral stenosis were chosen for PMC with Inue technique. Echocardiographic and homodynamic criteria were used as references for decision making during procedure .Systolic blood pressure changes were also evaluated by a fluid filled system at the end of each balloon inflation and deflation. To reach optimal results balloon inflation was done only once in one case (0.98%),twice in16.66% and three times in 82.35% of cases .in every stage of balloon inflation, trans-mitral gradient was compared with changes in systolic blood pressure. Results: correlation between systolic blood pressure drop and trans-mitral gradient changes were analyzed with Pearson method and via regression formula. Relation between final mitral orifice area and systolic blood pressure was also analyzed with T test. Significant relation was found in every stage:R;0.63 in stage 1,R:0.823 in stage 2, R:673in stage 3 in regression formula. Discussion: In order to find an easy and reliable method to assess results of PMC ,we chose systolic blood pressure changes ,because it could be reached via Gorlin formula and theoretically is related to mitral orifice area, practically it is easy to obtain in cath- lab, significant statistical relation was obtained with Pearson correlation and T test. Conclusion: Quick assessment of success during PMC is possible with monitoring of systolic blood pressure changes, an easy and practical way we could rely on. Introduction Until the first publication by Inoue and coworkers on percutaneus mitral commissurotomy (PMC) in 1984, surgery was the only treatment for patients with mitral stenosis. Most reports concerning PMC have been published since 1986. Since then a considerable evolution in this technique has occurred. A large number of patients have now been treated, enabling efficacy and risk to be assessed, and midterm results are available, so we are better able to select the most appropriate candidates for treatment by this method (1) Serial homodynamic measurement alone or in combination with echocardiography, may be used to evaluate the result achieved with PMC. (1) An immediate improvement in left atrial mean pressure (and reduction of the transmitral gradient) should be seen, with a gradual decrease in pulmonary artery pressure and an increase in cardiac output. Criteria for termination of procedure include: 1) a mitral valve area larger than 1 cm2 per square meter of body surface area. 2) Complete opening of at least one commissure or 3) appearance of an increase in mitral regurgitation. (1,2) In our cath lab, stepwise decision making and confirm of the stop point is based on hemodynamic measurements. By pooling back the catheter from left atrium to left ventricle after each inflation, the residual gradient and mitral regurgitataion are evaluated. But this technique lacks practibility and may be subjected to error. So we are presenting a novel method for stepwise decision making and for determing acute results after each stage of balloon inflation. Material and Methods Our study was performed between years 2002-2004 in catheterization department of Imam Reza hospital in Mashhad-Iran. We had 102 patients with moderate to severe MS whom were referred to our center for PMC (percutaneus mitral commissurotomy).Ttrans-thorasic echocardiography was performed in all cases pre-procedure. Patients with Wilkin’s score more than 12 were excluded from our study. We also excluded cases with more than two plus mitral regurgitation, and cases with other valvular involvement and inter-atrial septal defect. Demographic and hemodynamic data are shown in Table-1.