Immediate and Short-Term Impacts of Successful Percutaneous Transvenous Mitral Commissurotomy on Right Ventricular Function

Mitral valve is the most frequent valve that is affected by rheumatic heart disease. Abnormalities of Right Ventricular Function (RVF) play an important role in the development of clinical symptoms and the overall prognosis of patients with Mitral Stenosis (MS). Previous studies have shown discordant findings regarding the effect of Percutaneous Transvenous Mitral Commissurotomy (PTMC) on RVF.

This study aimed to evaluate the immediate and short-term impacts of PTMC on RVF using two-dimensional and tissue Doppler echocardiographic indices.

RVF was measured using transthoracic echocardiography indices (Tricuspid Annular Plane Systolic Excursion (TAPSE) and Peak Systolic Myocardial Velocity by DTI (RVSm)) in 75 patients with isolated severe MS presented to Rajaie Cardiovascular, Medical and Research Center between March 2016 and February 2019 before, after, and six months after PTMC.

All procedures were done successfully. The echocardiographic mean Mitral Valve Area (MVA) increased significantly from 1.0 ± 0.2 to 1.4 ± 0.2 cm (P < 0.001) and the mitral valve mean gradient decreased significantly from 10.2 ± 5.3 to 6.3 ± 2.8 mmHg after successful PTMC (P < 0.001). Systolic Pulmonary Artery Pressure (SPAP) also decreased significantly from 44.7 ± 11.3 to 35.9 ± 8.4 mmHg after PTMC (P < 0.001) and to 35.1 ± 6.7 mmHg after the six-month follow-up (P < 0.001). RVSm was 11.3 ± 2.5 cm/s before PTMC, which did not change immediately after that, but decreased to 12.1 ± 1.9 cm/s after the six-month follow-up (P < 0.003). TAPSE was 19.5 ± 4.3 mm before PTMC, which significantly increased to 21.1 ± 3.2 mm six months after PTMC (P < 0.005).

This study suggested that successful PTMC could improve RVF and decrease pulmonary artery pressure.