PERCUTANEOUS TRANSMITRAL COMMISSUROTOMY IN CHILDREN: INTERMEDIATE TERM RESULTS WITH SPECIAL REFERENCE TO PULMONARY HYPERTENSION

Objective: To know the long-term results of percutaneous transmitral commissurotomy (PTMC) and fate of pulmonary hypertension in children who have undergone PTMC. Material: During the last 11 years 138 children, aged 10.48 ± 2.24 years (range 3.5 -16) had PTMC. Indications were echocardiographic evidence of moderate to severe mitral stenosis (MS) plus pulmonary hypertension (PH) more than 50 mmHg and/or FC III-IV Result: Pre PTMC, mean pressure gradient (MPG) across the mitral valve (MV) was 18.6 mmHg ± 3.4 which decreased to 7.6 mmHg ± 2.21 .Mitral valve area (MVA) was 0.62 cm2 ± 0.12 which increased to 1.6 cm2 ± 0.3. Systolic Pulmonary artery pressure (SPAP) was 83 mmHg ± 13 decreased to 50 mmHg ± 14.5. Three procedures were unsuccessful. There were 2 deaths, one within half an hour in patient with SPAP of 100 mmHg and left ventricle (LV) dysfunction, had no mitral regurgitation (MR) ,arrhythmias or tamponade after PTMC. Another had thromboembolism of left anterior descending coronary artery during procedure; he revived and had successful PTMC but died after 24 hours. One had tamponade which was drained and had a successful PTMC after 1 week. There was no change in Mitral Regurgitation in 50 pts. After a mean follow-up period of 44.3 months ± 30.6 of 110 pts (10 months to 10 years), 8 needed repeat PTMC after 5.37 ± 2.3yrs (0.5–8 years), and 2 had mitral valve replacement (MVR) after 1 and 7 years. SPAP was 83 mmHg ± 13 pre procedures which decreased to 50 mm Hg ± 14.5 immediately after and to 42 mmHg ± 13 after 6 months. Immediately after PTMC, 54 pts had SPAP more than 50 mmHg and after 6 months only 24 pts .Out of these 2 died: one had severe PH despite adequate relief of MV, died after 3 years; another had mild MS and +2 MR with persistent severe PAH, had MVR after 1 year. PAP did not decline after surgery and he died two years after PTMC. Both had initial SPAP of more than 100 mmHg. Conclusion: PTMC is effective in reliving stenosis, however initial high PAP is predictor of persistent pulmonary hypertension