Key result
Percutaneous transvenous mitral commissurotomy improved leaflet excursion, with post-procedure subvalvular splitting area being a significant determinant of anterior leaflet excursion (B 0.16).
Why the study?
What are the echocardiographic and hemodynamic determinants of improvement in mitral valve leaflet mobility after PTMC in symptomatic patients with mitral stenosis?
Observational (n=291)
No
What are the echocardiographic and hemodynamic determinants of improvement in mitral valve leaflet mobility after PTMC in symptomatic patients with mitral stenosis?
Effect estimate: B 0.16 (95% CI 0.03 to 0.30)
p-value: p=< 0.05
Improvement in mitral leaflet excursion after PTMC is determined by morphologic and hemodynamic changes, with mobility increasing steeply until the mitral valve area reaches approximately 1.5 cm2.
May guide PTMC optimization via subvalvular splitting in mitral stenosis; extends mechanistic insights but leaves open outcome impact.
AIMS: PTMC produces significant changes in mitral valve morphology as improvement in leaflets mobility. The determinants of such improvement have not been assessed before. METHODS AND RESULTS: The study included 291 symptomatic patients with mitral stenosis undergoing PTMC. Post-PTMC subvalvular splitting area was a determinant of post-PTMC excursion in both the anterior (B 0.16, 95% CI 0.03 to 0.30, p < 0.05) and the posterior (B 0.12, 95% CI 0.01 to 0.24, p < 0.05) leaflets. Another determinant was the post-PTMC transmitral pressure gradient for anterior (B -0.02, 95% CI -0.04 to -0.005, p < 0.01) and posterior (B -0.01, 95% CI -0.04 to -0.005, p < 0.05) leaflets excursion. The relationship between post-PTMC MVA and leaflet excursion was non-linear "S curve". There was a steep increase of both anterior (p, 0.02) and posterior (p, 0.03) leaflets excursion with increased MVA till the MVA reached a value of about 1.5 cm2; after which both linear and S curves became nearly parallel. CONCLUSION: The improvement in leaflets excursion after PTMC is determined by several morphologic and hemodynamic changes produced in the valve. The increase in MVA improves mobility within limit; after which any further increase in MVA is not associated by a significant improvement in mobility in both leaflets.
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Hasan‐Ali et al. (2007) conducted an observational in Mitral stenosis (n=291). Percutaneous Transvenous Mitral Commissurotomy (PTMC) vs. Pre-procedure baseline was evaluated on Post-PTMC anterior leaflet excursion predicted by subvalvular splitting area (B 0.16, 95% CI 0.03 to 0.30, p=< 0.05). Percutaneous transvenous mitral commissurotomy improved leaflet excursion, with post-procedure subvalvular splitting area being a significant determinant of anterior leaflet excursion (B 0.16).
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