Difficulties to enter the left ventricle during percutaneous transvenous mitral commissurotomy (PTMC)- our experiences of 80 cases with modified techniques

Abstract

Background Percutaneous transvenous mitral commissurotomy (PTMC) is the standard of treatment for symptomatic severe rheumatic mitral stenosis (MS). PTMC has the standard Inoue technique, but we have to modify the procedure in many technically challenging cases, especially to cross the mitral valve. Methodology Two over-the-wire strategies to enter the LV were taken in 80 complex cases of PTMC. The first one was done by exchanging the J-shaped wire from the balloon, introducing the spring wire into it, and pushing it into LV. The second one-removal of balloon keeping the spring wire in LA and the Mullin's sheath was introduced, and the tip of the wire was pushed into LV, and the balloon was introduced over the wire. We also changed the left atrium (LA) graphy in the RAO view instead of the AP view to facilitating entry into LV. Results We succeeded in 76 (95 %) cases. Strategy one was applied to all but successful in only 25 cases (31 %), and strategy 2 was applied in the remaining. Strategy 1 required less procedural time and fluoroscopic time in comparison to strategy 2 (40 ± 10 vs 60 ± 16 min, 25 ± 7 vs 35 ± 8 min). After modification of taking the LA graphy in RAO view, our rate of facing the difficulties decreased from 21 % to 9 %. Critical MS (31 %) and the giant LA (30 %) were the topmost causes of difficulties. No major complications were recorded. Conclusion Over-the-wire entry into LV is cost-effective, requiring no new equipment and is safe and can be used in complex cases.

Incidence of Acute Mitral Regurgitation in Patients with Severe Mitral Stenosis after Post Percutaneous Transvenous Mitral Commissurotomy

“…It was found that PTMC was not only a safe and effective surgery but also greatly improved patients' QOL, underscoring the significance of providing this procedure at an earlier stage of the disease. According to a local study done in 2019 at the Combined Military Hospital in Pakistan, the authors did not notice any post-PTMC problems such localized hematoma, mitral regurgitation, or circulatory compromise [16][17] . The patients' success rate with PTMC (mean age, 40.3 ±2.8) was very high.…”