Immediate and short-term outcomes of percutaneous balloon mitral commissurotomy for severe mitral stenosis at a Resource Limited Setting, Addis Ababa, Ethiopia

Abstract

Background

Rheumatic heart disease is a common cause of mitral stenosis (MS) in developing nations. Percutaneous mitral balloon commissurotomy (PMBC) is the treatment of choice for patients with MS with favorable anatomy.

Objective

This study aimed to assess immediate and short-term outcomes of percutaneous balloon mitral commissurotomy for symptomatic patients with rheumatic severe mitral stenosis.

Methods

The clinical records of patients who underwent Percutaneous Mitral Balloon Commissurotomy (PBMC) at Saint Paul Hospital Millennium Medical College, Cardiac Center were reviewed. A retrospective observational study was conducted from February 01, 2018, to August 30, 2021. All eligible patients who underwent Percutaneous Mitral Balloon Commissurotomy during the study period at the cardiac center were included in this study. Ninety-one patients were enrolled in the study after excluding repeat procedures, those with incomplete data, and lost medical records. Data were collected through chart reviews using a structured questionnaire by trained physicians, with daily supervision by the investigators. Data analysis was performed using SPSS version 25. Associations were checked using a paired t-test and Fisher's Exact Test, with statistical significance set at a p-value of <0.05.

Result

Percutaneous mitral balloon commissurotomy was successful in 91.2 % of patients. Following the procedure, there was a significant increase in the mean mitral valve area from 0.799 cm² to 1.674 cm² and a reduction in the trans-mitral mean pressure gradient from 20 mmHg to 7.71 mmHg (P < 0.001). Atrial fibrillation and a high Wilkins score were identified as correlates of non-successful PMBC. A Wilkin's score of ≤8 and a post-procedure mitral valve area > 1.5 cm² were associated with New York Heart Association functional class improvement three months after the procedure.

Conclusion

In this study, percutaneous mitral balloon Commissurotomy (PMBC) demonstrated an excellent success rate. The majority of patients exhibited significant improvement in the New York Heart Association (NYHA) functional class.