ABSTRACT… Objectives: To evaluate the immediate outcomes of PTMC in patients with severe mitral valve stenosis. Study Design: Cross-sectional study. Setting: Ninety (90) subjects who underwent PTMC in Cardiac Catheterization Department of CPE Institute of Cardiology. Period: June 2008 to June 2011. Methods: Patients with severe MS having mitral valve (MV) area <1.0 cm 2 and having morphology suitable for PTMC in the absence of regurgitation and left atrial clot were included in this study. An increase in mitral valve area more than 50% of the baseline area without the development of moderate to severe MR was considered as the procedural success. Data were analyzed using SPSS V19. Pre and post procedural outcomes were measured using paired sample t-test. Results: There were a total number of ninety (90) patients in this study. Mean age of subjects was 28.08+9.61 years. There were more females 59 (65.5%) as compared to only 31 (34.5%) males. There was significant increase in mitral valve area, 1.83+0.36 cm 2 post-PTMC versus 0.63+0.17 cm 2 pre-PTMC (p-value <0.001). There was significant decrease in Peak pressure gradient (PPG) from 28.31+6.01 mmHg to 12.85+3.20 mmHg after PTMC (p-value <0.001). There were also significant reductions in mean pressure gradient and pulmonary artery systolic pressures after PTMC with p-value <0.001 and <0.001 respectively. PTMC was successful in 87 (97.7%) patients and it failed in only 3 (3.3%) patients. Conclusion: PTMC is an excellent treatment option regarding optimal outcomes and success rate in patients of severe mitral stenosis especially when performed by experienced interventionists. Key words:Mitral Stenosis, Percutaneous Transvenous Mitral Commissurotomy (PTMC), rheumatic fever, rheumatic heart disease.

Objectives: To evaluate the immediate outcomes of PTMC in patients with severemitral valve stenosis. Study Design: Cross-sectional study. Setting: Ninety (90) subjects whounderwent PTMC in Cardiac Catheterization Department of CPE Institute of Cardiology. Period:June 2008 to June 2011. Methods: Patients with severe MS having mitral valve (MV) area <1.0cm2 and having morphology suitable for PTMC in the absence of regurgitation and left atrial clotwere included in this study. An increase in mitral valve area more than 50% of the baseline areawithout the development of moderate to severe MR was considered as the procedural success.Data were analyzed using SPSS V19. Pre and post procedural outcomes were measured usingpaired sample t-test. Results: There were a total number of ninety (90) patients in this study.Mean age of subjects was 28.08+9.61 years. There were more females 59 (65.5%) as comparedto only 31 (34.5%) males. There was significant increase in mitral valve area, 1.83+0.36 cm2post-PTMC versus 0.63+0.17 cm2 pre-PTMC (p-value <0.001). There was significant decreasein Peak pressure gradient (PPG) from 28.31+6.01 mmHg to 12.85+3.20 mmHg after PTMC(p-value <0.001). There were also significant reductions in mean pressure gradient andpulmonary artery systolic pressures after PTMC with p-value <0.001 and <0.001 respectively.PTMC was successful in 87 (97.7%) patients and it failed in only 3 (3.3%) patients. Conclusion:PTMC is an excellent treatment option regarding optimal outcomes and success rate in patientsof severe mitral stenosis especially when performed by experienced interventionists.

Objective: To identify risk factors associated with mortality in COVID-19. Study Design: Retrospective Cross Sectional Study. Setting: Nishtar Hospital Multan. Period: April 2020 to September 2020. Material & Methods: Charts of all PCR confirmed COVID-19 cases expired during the study period. Results: Out of 96 cases, 62(64.6%) were male and 34(35.4%) were female. Sixty five (67.7%) were from urban areas. Niney two (95.8%) patients had a co-morbid condition. Fifty two (54.2%) had diabetes, 42(43.8%) had hypertension, 29(30.20%) had heart disease, 21(21.9%) had chronic kidney disease, 14(14.5%) had chronic lung disease and 5(5.2%) had chronic liver disease. Mean respiratory rate was 25.01±7.80, mean SaO2 was73.99±17.53 and 57(59.37%) had bilateral infiltrates on chest X-ray. Mean CRP was 59.95±46.28, mean S/LDH was 765.92 ±266.61, mean S/Ferritin was 1446.00±1261.69 and mean D-dimer was 1.26±0.45μg/ml. Thirty five (36.45%) had sepsis, 26(27.08%) had cytokine storm, 17(17.7%) had respiratory failure and 13(13.5%) had hypotension. Conclusion: Male gender, old age, diabetes, hypertension, ischemic heart disease and chronic kidney disease were associated with increased mortality in COVID 19. Tachypnea, hypoxia, bilateral infiltrates on chest X-ray and raised inflammatory markers also had poor prognosis. Sepsis, cytokine release syndrome, shock, and respiratory failure were common complications. These high risk patients with COVID 19 should be timely admitted and managed aggressively to improve outcome.