Key result
Patients with significant tricuspid regurgitation after percutaneous mitral commissurotomy had significantly higher systolic pulmonary arterial pressure (60.5 vs 38.5 mmHg) and right-sided echocardiographic parameters at 24 hours compared to those with insignificant tricuspid regurgitation.
Why the study?
There is a gap in evidence regarding the management of multivalvular lesions, requiring more data on clinical and echocardiographic outcomes after percutaneous mitral commissurotomy.
Does Percutaneous Mitral Commissurotomy improve tricuspid regurgitation and echocardiographic parameters in patients with severe mitral stenosis and moderate to severe tricuspid regurgitation?
Cohort (n=38)
No
Does Percutaneous Mitral Commissurotomy improve tricuspid regurgitation and echocardiographic parameters in patients with severe mitral stenosis and moderate to severe tricuspid regurgitation?
Percutaneous mitral commissurotomy improves echocardiographic parameters and functional class in patients with severe mitral stenosis and moderate to severe tricuspid regurgitation, with most patients showing insignificant TR at 6 months.
PURPOSE The gap in evidence in the management of multivalvular lesions can be addressed by providing more data on clinical and echocardiographic outcomes after Percutaneous Mitral commissurotomy (PMC). METHODS Participants were Filipinos aged >/= 19 years old, admitted due to severe mitral stenosis with moderate to severe tricuspid regurgitation (TR). The outcome of PMC was divided into 2 groups: Significant TR which included the progression of moderate to severe TR or persistence of severe TR and Insignificant TR group which included those with mild TR, regression to moderate to mild TR, severe to moderate, or persistence of moderate TR. These groups were compared from baseline, 24th hour, 1st month, and 6th month using the same echocardiographic parameters. The numerical data between significant and nonsignificant tricuspid regurgitation were compared using non-parametric Mann Whitney U test and categorical data using the Chi-Square test. RESULTS A total of 38 participants were analyzed. On the 24th-hour post- PTMC, the Significant TR group had significantly higher RAVI (42.3 vs 26.1, p=.004), RVD mid (3.81 vs 2.92, p=.001), SPAP (60.5 vs 38.5, p=.003), and RVOT (2.8 vs 2.2, p=.001) and lower MV planimetry (1.25 vs 1.58, p=.009); On the 1st-month RVD mid (3.4 vs 2.8, p=.02) and TV annulus (3.35 vs 2.76, p=0.10) were significantly higher in the Significant TR group; On the 6th month RAVI (59 vs 24.7, p=.001), RVD mid (4 vs 2.73, p=.006), and TV annulus (4.5 vs 2.67 p=.001) were significantly higher in the Significant TR group when compared to Insignificant TR group. CONCLUSION PMC improved baseline parameters of SPAP, MV planimetry, MV gradient, and functional class on short-term follow-up on both groups of TR. Majority of outcomes after the procedure had insignificant TR. However, those with significant TR had higher RVD mid and TV annulus from the 24th hour to 6 months when compared to the insignificant TR group.
No takes yet. Share an insight, caveat, or question.
Toledano et al. (2021) conducted a cohort in Severe mitral stenosis with moderate to severe tricuspid regurgitation (n=38). Significant tricuspid regurgitation post-PMC vs. Insignificant tricuspid regurgitation post-PMC was evaluated on Systolic pulmonary arterial pressure (SPAP) at 24 hours post-PMC (p=0.003). Patients with significant tricuspid regurgitation after percutaneous mitral commissurotomy had significantly higher systolic pulmonary arterial pressure (60.5 vs 38.5 mmHg) and right-sided echocardiographic parameters at 24 hours compared to those with insignificant tricuspid regurgitation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: