Immediate and delayed effects of successful percutaneous transvenous mitral commissurotomy on global right ventricular function in patients with isolated mitral stenosis.
Global right ventricular function of the pressure-overloaded right ventricle in patients with mitral stenosis and pulmonary hypertension after successful percutaneous transvenous mitral commissurotomy (PTMC) has not been well-defined. With the use of a recently developed Doppler method for estimating right ventricular function in human beings, we studied 25 consecutive patients with isolated rheumatic mitral stenosis before, immediately after (mean, 40+/-12 h) and at a mean follow-up of 11.5 months after PTMC. Immediately after percutaneous mitral commissurotomy, there was a significant increase in mitral valve area (P = 0.000017) along with a decrease in mean pulmonary pressure (P = 0.001). The index was not affected immediately after successful PTMC (0.70+/-0.25 vs., 0.58+/-0.18; P = 0.06); however, at follow-up of about one year, the index showed a significant decrease (0.697+/-0.28 vs. 0.380+/-0.13; P = 0.0008, n = 24). The change in the index was characterised by a significant prolongation of the right ventricular ejection time, with a decrease in the isovolumic intervals. The Doppler index of combined right ventricular function was significantly correlated to the mean pulmonary artery pressure (r = 0.695, P<0.001) and systolic pulmonary artery pressure (r = 0.60, P = 0.007) before PTMC and also immediately after the procedure; however, at follow-up, the index had no correlation with the Doppler estimated pulmonary artery systolic pressure (r = 0.07). Despite a larger mitral valve area following PTMC, right ventricular isovolumic indices remain abnormal on mid-term follow-up, although global function tends to normalise in two-thirds of the patients.
Mohan
J C
JC
Department of Cardiology, G.B. Pant Hospital, New Delhi, India. jcm@del2.vsnl.net.in
Sengupta
P P
PP
Arora
R
R
D000328:Adult; D002404:Catheterization / Q000379:methods*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D009200:Myocardial Contraction; D015588:Observer Variation; D011669:Pulmonary Wedge Pressure; D013318:Stroke Volume; D016896:Treatment Outcome; D016278:Ventricular Function, Right