Adnan Mehmood Gul, Tariq Nawaz, Muhammad Saad Jibran.
Twenty years experience of successful percutaneous transmitral commisurotomy performed through patent foramen ovale.
Pak Heart J Jan ;50(4):205-8.

Objective: To assess the efficacy and effectiveness of PTMC through patent foramen ovale in patients with symptomatic mitral stenosis. Methodology: This cross sectional study included patients with symptomatic mitral stenosis from January 1995 to December 2016, at Lady Readnig Hospital,Cardiology Department. All patients were subjected to detailed clinical examination. BLIs were performed. (TTE and TEE) was performed to exclude LA/LAA clot, to assess the calcification of mitral valve and check the anatomy of inter ventricular septum. Patients with severely calcified mitral valve and with +2 mitral regurgitation were excluded. PFO was crossed in majority of cases to reach LA. Mitral valve stenosis was relieved with Inoue balloon. Result: Total number of patients enrolled was 3751. Females were 76%. The mean age was 27.5+- 7.2 years. Mean BMI was 19.8+-2.1 kg/m . PTMC of 92.08% patients was performed through PFO. Mean valve area was 0.9+-0.21cm on 2D echocardiography, which was successfully dilated upto 1.82+-0.17cm (p>0.05). Mitral valve gradient decreased from 18 +- 4.08 mm of Hg to 7.0 +- 0.25 mm of Hg (p< 0.005). Mean right ventricular systolic pressure decreased from 70 +- 17.4 mm of Hg to 48 +- 13mm of Hg with 32% drop of pressure at 24 hrs post PTMC (p<0.05). Post PTMC mitral regurgitation was sound in 3.6% in PFO group and 2.8% in inter atrial septum group. Pericardial effusion was found in 0.11% patients in PFO group and 0.27% in inter atrial septum group (p > 0.05). Abandonment rate of PTMC through PFO was quite less 0.57% as compared to PTMC through septal puncture 2.69%. Conclusion: PTMC through PFO is effective, safe and user friendly procedure with fewer complication rates.

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