title: Percutaneous transvenous mitral commissurotomy in juvenile mitral stenosis.
abstract: BACKGROUND
  Percutaneous transvenous mitral commissurotomy (PTMC) is a valid alternative to surgical therapy in selected patients with mitral stenosis. Juvenile mitral stenosis (JMS) varies uniquely from adult rheumatic heart disease (RHD). We aimed to evaluate the efficacy of PTMC in JMS patients.
  
  
  METHODS
  It was a single centre, retrospective study conducted between July 2013 to June 2015 in Shahid Gangalal National Heart Centre, Kathmandu, Nepal. Medical records of all consecutive patients aged less than 21 years who underwent PTMC were included. Mitral valve area (MVA), left atrial pressure and mitral regurgitation (MR) were compared pre and post procedure.
  
  
  RESULTS
  During the study period 131 JMS patients underwent PTMC. Seventy (53.4%) were female and 61 (46.6%) were male. Among the 131 patients, 40 (30.5%) patients were below the age of 15 years. Patient age ranged between 9 to 20 years with the mean of 16.3±2.9 years. Electrocardiography (ECG) findings were normal sinus rhythm in 115 (87.7%) patients and atrial fibrillation in 16 (12.3%) patients. Left atrial size ranged from 2.9 to 6.1 cm with the mean of 4.5±0.6 cm. The mean MVA increased from 0.8±0.1 cm(2) to 1.6±0.2 following PTMC. Mean left atrial pressure decreased from their pre-PTMC state of 27.5±8.6 to 14.1±5.8 mmHg. Successful results were observed in 115 (87.7%) patients. Suboptimal MVA <1.5 cm(2) in 11 (8.4%) patients and post-procedure MR of more than moderate MR in 5 (3.8%) patients was the reason for unsuccessful PTMC.
  
  
  CONCLUSIONS
  PTMC in JMS is safe and effective.
authors.affiliation: 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal.
authors.forename: Chandra Mani
authors.initials: CM
authors.lastname: Adhikari
authors.affiliation: 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal.
authors.forename: Rabi
authors.initials: R
authors.lastname: Malla
authors.affiliation: 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal.
authors.forename: Rajib
authors.initials: R
authors.lastname: Rajbhandari
authors.affiliation: 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal.
authors.forename: Urmila
authors.initials: U
authors.lastname: Shakya
authors.affiliation: 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal.
authors.forename: Poonam
authors.initials: P
authors.lastname: Sharma
authors.affiliation: 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal.
authors.forename: Nagma
authors.initials: N
authors.lastname: Shrestha
authors.affiliation: 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal.
authors.forename: Bishal
authors.initials: B
authors.lastname: Kc
authors.affiliation: 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal.
authors.forename: Deepak
authors.initials: D
authors.lastname: Limbu
authors.affiliation: 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal.
authors.forename: Man Bahadur
authors.initials: MB
authors.lastname: Kc
keywords: Juvenile mitral stenosis (JMS); mitral stenosis; percutaneous transvenous mitral commissurotomy (PTMC)