Introduction:

Rheumatic heart disease, which is extremely prevalent in Pakistan, most commonly affects the mitral valve. Percutaneous transvenous mitral commissurotomy (PTMC) is the procedure of choice for the treatment of mitral stenosis (MS). A range of echocardiographic parameters may affect the outcomes of PTMC.

Objectives:

The objectives of this study were to compare the efficacy of PTMC in MS patients with varying echocardiographic scores.

Method:

This was a comparative observational study conducted at the Department of Cardiology Lady Readings Hospital in Peshawar, Pakistan using non-probability consecutive sampling. Patients with MS who had a Wilkins score below 12, less than moderate mitral regurgitation (MR), and no left atrium/left atrial (LA) appendage clot were included in the study. Patients were divided into Group A if their Wilkin’s score was eight or lower, and Group B if their score was nine to 11.

Results:

Of the total 207 patients who enrolled in the study, 175 were included in the study. One hundred and forty-one patients were assigned into Group A, and 34 were assigned into Group B. Mean age, male-to-female ratio, and other baseline characteristics were similar in both groups. Overall, 92% of patients showed an increase in the mitral valve area (MVA). Most patients (94.3% of Group A, 76.5% of Group B, respectively) demonstrated an increase in MVA (p = 0.001). Pulmonary artery pressure improved in 97.9% of Group A patients and 94% of Group B patients (p = 0.19). All patients demonstrated an improved mitral valve gradient. Most (97.9%) of Group A patients and 94% of Group B patients demonstrated LA volume regression (p = 0.019). Some patients (9.2% of Group A patients and 10.5% of Group B patients) showed and worsened MR (p = 0.8).

Conclusion:

PTMC is successful in patients with both low and high Wilkins scores in terms of improvement in pulmonary artery pressure, LA volume regression, and mitral valve gradient. Improvement in the MVA is not affected by the grade of Wilkins score. Thus, our study suggests that Wilkins score may not be an optimal parameter for pre-PTMC evaluation.

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