title: Percutaneous transvenous mitral commissurotomy in mitral stenosis and left atrial appendage clot patients in special conditions: Hospital-based study.
abstract: BACKGROUND
  The percutaneous transvenous mitral commissurotomy is an important procedure for the treatment of mitral stenosis. A lot of mitral stenosis cases have left atrial appendage clot which precludes the patient from the benefit of this procedure. The aim of the study was to study the feasibility and safety of the procedure in a patient with appendage clot in the setup of certain urgent conditions.
  
  
  METHODS
  All cases of mitral stenosis with significant dyspnea and mitral valve area <1.5cm2with left atrial appendage clot and a condition which would preclude the patient from continuing on anticoagulation and needed urgent intervention were included in the study. From January 2011 to December 2013, twenty patients coming to Shahid Gangalal National Heart Centre, Kathmandu were selected for the procedure with conventional sampling technique. Informed written consent was obtained from the patients explaining all possible complications. The approval of the study was taken from the ethical committee of the hospital.
  
  
  RESULTS
  Mean mitral valve area increased from 0.90cm2(SD±0.14) to 1.5cm2(SD±0.21) (p=0.02). Left atrial mean pressure decreased from mean of 20 to 10mmHg. Subjective improvement was reported in all. All of the patients had fulfilled criteria for successful PTMC. There was no mortality during hospital stay or in one-week follow-up period. There were no neurological complications or any need for emergency surgery.
  
  
  CONCLUSIONS
  The immediate result of percutaneous transvenous mitral commissurotomy in selected cases of mitral stenosis with left atrial appendage clot is safe and acceptable in certain urgent situations in experienced hands.
authors.affiliation: Shahid Gangalal National Heart Centre, Kathmandu, Nepal. Electronic address: rajibrbhandari@yahoo.com.
authors.forename: Rajib
authors.initials: R
authors.lastname: Rajbhandari
authors.affiliation: Shahid Gangalal National Heart Centre, Kathmandu, Nepal.
authors.forename: Rabi
authors.initials: R
authors.lastname: Malla
authors.affiliation: Shahid Gangalal National Heart Centre, Kathmandu, Nepal.
authors.forename: Arun
authors.initials: A
authors.lastname: Maskey
authors.affiliation: Shahid Gangalal National Heart Centre, Kathmandu, Nepal.
authors.forename: Yadav
authors.initials: Y
authors.lastname: Bhatta
authors.affiliation: Shahid Gangalal National Heart Centre, Kathmandu, Nepal.
authors.forename: Yubraj
authors.initials: Y
authors.lastname: Limbu
authors.affiliation: Shahid Gangalal National Heart Centre, Kathmandu, Nepal.
authors.forename: Ranjit
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Shahid Gangalal National Heart Centre, Kathmandu, Nepal.
authors.forename: Satish
authors.initials: S
authors.lastname: Singh
authors.affiliation: Shahid Gangalal National Heart Centre, Kathmandu, Nepal.
authors.forename: Chandramani
authors.initials: C
authors.lastname: Adhikari
authors.affiliation: AIIMS, New Delhi, India.
authors.forename: Sundeep
authors.initials: S
authors.lastname: Mishra
mesh_terms: D000328:Adult; D020517:Atrial Appendage; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002406:Catheterization, Peripheral / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D005268:Femoral Vein; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Left atrial appendage clot; Mitral stenosis; PTMC