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Percutaneous Transvenous Mitral Commissurotomy in Elderly Mitral Stenosis Patients. A Retrospective Study at Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal
Chandra Mani ADHIKARI, Rabi MALLA, Rajib RAJBHANDARI, Yadav Kumar BHATTA, Arun MASKEY, Suman THAPALIYA, Prakash GURUNG and KC MAN BAHADUR
ABSTRACT
Introduction: Percutaneous transvenous Mitral Commissurotomy (PTMC) has been shown to be a valid alternative to surgical therapy in selected patients with mitral stenosis. Though its efficacy in children and young adults is already established, its role in elderly patients is not well reported. We aimed to evaluate the efficacy of PTMC in elderly patients (≥60 years).
Methods: All elderly patients who underwent PTMC from March 2008 to March 2013 were retrospectively reviewed. Mitral valve area and mean left atrial pressure before and after the procedure were compared.
Results: During the study period 49 elderly patients underwent PTMC. Thirty eight were female and 11 male. Age ranged from 60 to 77 years with the mean age of 64.5±4.0 years. The mean mitral valve area increased from 0.9±0.1 cm2 to 1.6±0.3 cm2 whereas mean left atrial pressure decreased from 25.4±6.6 mmHg to 12.9±4.5. Successful results were observed in 41 (83.6%) patients. Unsuccessful results were due to suboptimal mitral valve area <1.5 cm2 in 7 (14.25%) patients and post-procedure MR of more than moderate MR in 1(2%) patients. Unsuccessful PTMC was much more common in severe than in moderate mitral stenosis.
Conclusions: Our study suggests that PTMC in elderly is a safe and effective procedure when performed in experienced centre by experienced operators.
Keywords: elderly, percutaneous transvenous mitral commissurotomy, mitral stenosis