Abstract
Background: Rheumatic fever and rheumatic heart disease continue to be endemic and leads the major acquired heart disease in India and other developing countries. The incidence of rheumatic fever and rheumatic mitral stenosis is very high in our country, having an incidence of 25-45% of the acquired heart disease, with a women to men ratio of 2:1. Percutaneous balloon mitral commissurotomy is the best mode of nonsurgical treatment offering better results in suitable valves. Mitral leaflet separation (MLS) index is one of the best method to assess the severity of mitral stenosis. The aim of this study is to assess the Mitral valve area before and after percutaneous balloon mitral valvuloplasty using Mitral leaflet separation index in a tertiary care center
Methods: A retrospective study was done in the Institute of Cardiology, Madras Medical College, Chennai, Tamil nadu. Fifty patients with rheumatic mitral stenosis who underwent Percutaneous balloon mitral commissurotomy were evaluated clinically and echocardiographically during and after the procedure. In all patients the Mitral valve stenosis severity was assessed using mitral valve area in 2D echo by planimetry, pressure half time and mitral leaflet separation index. The mitral leaflet separation index (MLS) was estimated by measuring average of distance between the maximal separation of tip of mitral valve leaflets in end-diastole in parasternal long axis and four chamber echocardiographic views.
Results: In our study, the mean age of the population was 20.51 ± 10.22 years and included mostly female gender (83%). The mitral valve area measured after Balloon valvotomy increased from 0.80 ± 0.13 cm2 to 1.65 ± 0.36 cm2 as measured by echocardiography. Pre procedure PTMC the mean MVA (PHT) was 0.80 ± 0.25 cm2 and MLS index was 5.75 to 6.25 mm. and after the procedure (PTMC) the mean MVA (PHT) was 1.65 ± 0.36 cm2 and Mitral leaflet separation index (MLSI) was 10.22 to 15.55 mm. In our study we noted, better correlation between the measured mitral valve area by echocardiography and mitral leaflet separation index (MLSI) (r = 0.36, p= 0.0132) and also between MVA (PHT) and mitral leaflet separation index (MLSI) (r = 0.54, p = 0.0001).
Conclusion: By using simple non invasive, easily available echocardiography method, the mitral leaflet separation index (MLSI) we can assess the severity of mitral stenosis before and after Percutaneous balloon mitral commissurotomy (PTMC).
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Corresponding Author
Dr Ravishankar Govindarajulu
Professor of Cardiology, Institute of Cardiology, Madras Medical College, Chennai, India
DOI: https://dx.doi.org/10.18535/jmscr/v6i7.178
