Hemodynamic Evaluation of Mitral Stenosis Before and After PTMC Using Stress Echocardiography

The aim of this study was to evaluate the success of PTMC hemodynamically. The hemodynamic data have been evaluated by exercise stress echocardiography in patients with mitral stenosis (MS) following PTMC.
We prospectively studied hemodynamic data in 15 consecutive patients with severe MS who were in NYHA FC two or more. The valve score was less than 9. All the patients underwent PTMC. Treadmill exercise stress echocardiography (Bruce protocol) was done before and one month after PTMC with GE Vingmed CFM 800. Mitral valve area by planimetry and the PHT method, mean TMVG, peak TMVG and PAP were measured in all the patients at rest and within 90 seconds after the termination of exercise.
PTMC was successful in 63% of the patients according to an increased mitral valve area (P=0.001), a decreased post-PTMC mean and peak pressure gradients before and after exercise (P=0.008), and increased exercise tolerance (P=0.016). The mean age of the patients with successful PTMC was lower than that of patients with unsuccessful procedures (38.18±8.15 vs. 43.5±3.1). Exercise tolerance was
lower in older patients before and also after successful PTMC.
This study shows that the accurate and reliable indicators of successful PTMC in the cardiac catheterization laboratory are an increased mitral valve area as well as a decreased post-procedural mean TMVG. Therefore, planimetry of the mitral valve using transthoracic echocardiography immediately after PTMC is recommended