title: Predictors of successful percutaneous transvenous mitral commissurotomy using the Bonhoeffer Multi-Track system in patients with moderate to severe mitral stenosis: Can we see beyond the Wilkins score?
abstract: OBJECTIVE
  To know the predictors of a successful outcome of percutaneous transvenous mitral commissurotomy (PTMC) other than described in the Wilkins scoring system.
  
  
  METHODS
  Two hundred fifty-eight consecutive patients were enrolled for this observational study in a tertiary care heart center of Pakistan who had a Wilkins score of ≤ 8. Patients with more than mild mitral regurgitation (MR) or having a clot in the left atrium were excluded. The Bonhoeffer multi-track system was used as a default technique. Successful PTMC was defined as achieving a mitral valve area (MVA) of ≥ 1.5 cm(2) with no more than mild MR.
  
  
  RESULTS
  Out of 258 PTMC procedures, 197 were successful. The Bonhoeffer multi-track system was used in ~94% cases. Among unsuccessful procedures, 41 patients did not achieve the required valve area, and 21 patients developed more than mild MR, including those 8 patients who did not achieve the required valve area and had more than mild MR. Bigger mean annulus size (33.5 ± 2.6 versus 32.8 ± 2.1 mm; p=0.02) and preprocedure MVA (0.93 ± 0.1 versus 0.87 ± 0.1 cm(2); p=0.002) had a significant effect on successful PTMC. Lower mean preprocedure systolic right ventricular pressure on echo (65.4 ± 19.4 versus 75.3 ± 18 mm Hg; p=0.000) and on cath (74 ± 21.5 versus 81.5 ± 24.6 mm Hg; p=0.002), lower grade of left ventricular dysfunction (p=0.04), and tricuspid regurgitation on echo (p=0.003) also had positive effects on the outcome.
  
  
  CONCLUSIONS
  Bigger preprocedure mitral valve annulus size and mitral valve area, and better left and right ventricular hemodynamics are correlated with successful PTMC.
authors.affiliation: Jinnah Medical College Hospital; Karachi-Pakistan. tariqfarman@yahoo.com.
authors.forename: Muhammad Tariq
authors.initials: MT
authors.lastname: Farman
authors.forename: Naveedullah
authors.initials: N
authors.lastname: Khan
authors.forename: Jawaid Akbar
authors.initials: JA
authors.lastname: Sial
authors.forename: Tahir
authors.initials: T
authors.lastname: Saghir
authors.forename: Tariq
authors.initials: T
authors.lastname: Ashraf
authors.forename: Syed Ishtiaq
authors.initials: SI
authors.lastname: Rasool
authors.forename: Khan Shah
authors.initials: KS
authors.lastname: Zaman
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D058386:Mitral Valve Annuloplasty / Q000379:methods*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D011183:Postoperative Complications; D012720:Severity of Illness Index; D016896:Treatment Outcome