Assessment of RV function following Percutaneous Transvenous Mitral Commissurotomy (PTMC) for rheumatic mitral stenosis

摘要

Objective: Abnormal right ventricular function plays an important role in development of clinical symptoms and overall prognosis of patients with mitral stenosis. Hemodynamic and radionuclide studies have demonstrated long-term improvement in RV function after PTMC. However, exact quantification by conventional echocardiographic technique is difficult owing to complex 2D anatomy. This study evaluates the immediate and short term follow up impact of successful percutaneous transvenous mitral valve commissurotomy (PTMC) on RV function in patients with mitral stenosis using 2D Echo and Doppler tissue imaging. Methods: 219 patients (mean age 26 + 6yrs) with rheumatic MS, all in sinus rhythm were studied before and 24-48 hrs after PTMC. Parameters of global and longitudinal RV function were assessed by conventional 2D ECHO and Doppler tissue imaging. Results: Immediately following PTMC, mitral valve area increased from baseline of 0.71 ± 0.15 cm2 to 1.84 ± 0.17 cm2 (P 0.0001), RV outflow tract fractional shortening (RVOT–FS) increased from 33.94 ± 7.55% to 37.33 ± 7.67% (<0.001). There was a significant decrease in systolic pulmonary artery pressure from 48.93 ± 13.08 mmHg to 29.56 ± 7.71 (P<0.0001). RV Tei- index decreased from 0.47 ± 0.12 to 0.32 ± 0.11 (P 0.001). Conclusion: Long term evaluation of RV function and benefits using invasive and radionuclide methods post PTMC has shown incongruous results in improvement of right ventricular (RV) function immediately after PTMC. In this study, immediately after successful PTMC significant improvement in parameters of infundibular and global RV function as assessed by RVOT fractional shortening , Tei index and tissue Doppler velocities was observed.