Key result
Successful Percutaneous Transvenous Mitral Commissurotomy (PTMC) resulted in a significant decrease in spontaneous echo contrast (SEC) grading among patients with severe rheumatic mitral stenosis.
Why the study?
LAA dysfunction is common in mitral stenosis, but its relationship with SEC and the effect of successful PTMC on SEC grading required evaluation.
Does successful PTMC improve spontaneous echo contrast (SEC) grading and left atrial appendage function in patients with severe rheumatic mitral stenosis?
Observational (n=75)
No
Does successful PTMC improve spontaneous echo contrast (SEC) grading and left atrial appendage function in patients with severe rheumatic mitral stenosis?
Successful percutaneous transvenous mitral commissurotomy significantly reduces spontaneous echo contrast, which is a marker of severe left atrial appendage dysfunction in rheumatic mitral stenosis.
May lower thromboembolic risk via reduced LA stasis in rheumatic MS; hypothesis-generating and needs prospective confirmation.
Background: Left Atrial Appendage (LAA) dysfunction is common in patients of Mitral stenosis (MS). In the present study we compared the LAA function amongst patients of severe rheumatic MS with particular reference to spontaneous echo contrast (SEC) and evaluated the effect of successful Percutaneous Transvenous Mitral Commissurotomy (PTMC) on SEC grading. Methods: It was a single centre prospective descriptive type of study. Total 75 cases were included during the study period from 2016 to 2020. Symptomatic patients with severe rheumatic mitral stenosis (MVA<1.5cm²) in sinus rhythm fulfilling the elective PTMC intervention criteria and those who had a successful intervention only were included. All the patients underwent Clinical examination, ECG, detailed TTE and TEE before, Immediately after (within 24hrs) & after 6 months of PTMC. Results: In the present study mean LAAAC% and LAA PW Doppler velocities were significantly less in patients of severe rheumatic Mitral Stenosis having SEC than patients without SEC, implying more severe LAA dysfunction in patients with SEC. LAA Tissue Doppler velocities were also less in patients with SEC compared to patients without SEC but it was statistically not significant. There was a significant negative correlation between SEC grading and LAAAC (%) and LAA PW Doppler velocities (LAAEDE Velocity, LAALDE Velocity and LAAF velocity), i.e. greater the degree of SEC lesser was the LAAAC (%), LAAEDE Velocity, LAALDE Velocity and LAAF velocity, suggesting more severe LAA dysfunction in patients with greater degree of SEC. There was also negative correlation between SEC grading and LAA Tissue Doppler velocities (ELAA Velocity, ALAA Velocity, SLAA Velocity) but it was statistically not significant. Successful PTMC resulted in significant decrease in SEC grading. Conclusion: Among the patients of severe rheumatic mitral stenosis, presence of SEC implies severe LAA dysfunction, greater the intensity of SEC, greater would be the severity of LAA dysfunction and successful PTMC results in improvement of SEC grading.
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Ansari et al. (2020) conducted an observational in Severe rheumatic mitral stenosis (n=75). Percutaneous Transvenous Mitral Commissurotomy (PTMC) vs. Baseline (before PTMC) was evaluated on Left Atrial Appendage (LAA) function and spontaneous echo contrast (SEC) grading. Successful Percutaneous Transvenous Mitral Commissurotomy (PTMC) resulted in a significant decrease in spontaneous echo contrast (SEC) grading among patients with severe rheumatic mitral stenosis.
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