Adnan Mehmood Gul, Shah Zeb, Umar Hayat, Mohammad Irfan, Mohammad Hafizullah.
Right ventricular failure in spite of successful percutaneous mitral commissurotomy in patients with severe mitral stenosis.
Pak Heart J Jan ;48(2):83-9.

Objective: To know the frequency of right ventricular failure inspite of successful percutaneous mitral commissurotomy (PTMC) for isolated severe mitral stenosis. Methodology: This observational study was conducted from January 2011 to December 2014 in Cardiology Department of Lady Reading Hospital, Peshawar.Patients with severe isolated mitral stenosis after successful PTMC were followed for one year. Patients who develop symptoms of right ventricular failure were subjected to detailed transthoracic echocardiogram (TTE) including assessment of right ventricular function. Results: A total of 307 patients with severe isolated mitral stenosis who had successful PTMC were studied. Females were 185(60.26%) and males were 122(39.74%). Mean age was 26.44+-7.26 years. TTE performed before PTMC showing mean mitral valve area 0.9cm +-0.24cm . TTE 24 hours after PTMC showed mean left atrial diameter 4.68+-3.1cm, mean mitral valve area 2 1.67+-0.71cm , mean mitral valve gradient 5.42+-4.6 mm of Hg, mean right ventricular systolic pressure (RVSP) 43+-18.41 mm of Hg. After follow up for one year, 27(8.79%) patients developed signs and symptoms of congestive heart failure. Of these, 10(3.25%) patients were found to have right heart ventricular dysfunction with no previous echocardiographic documented right ventricular dysfunction. Their mean age was 37.21+-6.26 years, of them, 6(60%) were males and 4(40%) females. Mean RVSP 24 hours post PTMC was 63+-10.21mm of Hg, mean LA diameter 5.18+- 1.82cm and mean LVEF 50.14%+- 5.82. Conclusion: Patients with severe mitral stenosis who were older and who had higher right ventricular systolic pressure were more prone to develop right ventricular failure in spite of successful PTMC.

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