title: Patient profile and results of percutaneous transvenous mitral commissurotomy in mitral restenosis following prior percutaneous transvenous mitral commissurotomy vs surgical commissurotomy.
abstract: BACKGROUND
  Patients with mitral restenosis who have undergone prior PTMC or surgical commissurotomy have increased. Predictors of outcome of repeat PTMC in either subgroup of patients may be different.
  
  
  OBJECTIVE
  Aim was to assess and compare the immediate results of PTMC in patients who had undergone a prior PTMC or surgical commissurotomy.
  
  
  RESULTS
  This is a single center, prospective, open label study. Of 70 patients in study, 44 (62.85%) patients had prior history of PTMC and 26 (37.15%) had prior surgical commissurotomy (closed/open). Average time from the initial procedure was 8.88 ± 5.36 years overall, 6.75 ± 3.38 for patients with prior PTMC and 16.73 ± 3.67 for patients with prior surgical commissurotomy. Prior PTMC group had 75% female, patients with prior surgical commissurotomy were older (44 ± 7 vs 33.57 ± 9.1 years, p = 0.001), had higher NYHA class (III/IV in100% vs 86.36%, p = 0.006.), higher atrial fibrillation (73.1% vs 25% p < 0.0001) and higher Wilkins' score (>8 in 88.46% vs 68.18%, p = 0.05). Successful PTMC was lower (65.4% vs 84.1%) in patients with prior surgical commissurotomy, though statistically not significant (p = 0.07). After PTMC, mitral valve area, PA systolic pressure, LA mean pressure and trans-mitral gradient were similar. Post procedure complications were not different in both the groups.
  
  
  CONCLUSIONS
  PTMC for mitral restenosis in patients with prior surgical valvotomy is as effective as in patients with prior PTMC despite older age, higher NYHA class, higher Wilkins score and atrial fibrillation and can be considered in all patients with restenosis irrespective of the type of past procedures done.
authors.affiliation: Associate Professor Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Asarwa, Ahmedabad, Gujarat, India.
authors.forename: Kamal H
authors.initials: KH
authors.lastname: Sharma
authors.affiliation: Associate Professor Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Asarwa, Ahmedabad, Gujarat, India.
authors.forename: Sharad
authors.initials: S
authors.lastname: Jain
authors.affiliation: Associate Professor Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Asarwa, Ahmedabad, Gujarat, India.
authors.forename: Anand
authors.initials: A
authors.lastname: Shukla
authors.affiliation: Assistant Professor Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Asarwa, Ahmedabad, Gujarat, India.
authors.forename: Shomu
authors.initials: S
authors.lastname: Bohora
authors.affiliation: Assistant Professor Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Asarwa, Ahmedabad, Gujarat, India.
authors.forename: Bhavesh
authors.initials: B
authors.lastname: Roy
authors.affiliation: DM Resident, Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Asarwa, Ahmedabad, Gujarat, India. Electronic address: drgg_29@yahoo.co.in.
authors.forename: Gaurav D
authors.initials: GD
authors.lastname: Gandhi
authors.affiliation: DM Resident, Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Asarwa, Ahmedabad, Gujarat, India.
authors.forename: A J
authors.initials: AJ
authors.lastname: Ashwal
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods*; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects* / Q000379:methods; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation / Q000379:methods / Q000401:mortality; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Mitral restenosis; Percutaneous transvenous mitral commissurotomy; Surgical commissurotomy