Study of Immediate and Late Effects of Successful PTMC on Left Atrial Appendage Function in Patients with Severe Rheumatic Mitral Stenosis IN SINUS Rhythm

Overview

Journal Indian Heart J

Publisher Elsevier

Specialty Cardiology & Vascular Diseases

Date 2020 Aug 10

PMID 32768017

Citations 4

Authors

Basheeruddin Ansari

Sumaira Siddiqui

Vijay Barge

Pravat Kumar Dash

Affiliations

Soon will be listed here.

Abstract

Introduction: Since its introduction in 1984, Percutaneous Transvenous Mitral Commissurotomy (PTMC) has become established as a safe and effective treatment for rheumatic Mitral Stenosis (MS).( Ben Farhat et al., 1998) 1 Chronic pressure and volume overload imposed by MS causes left atrial (LA) and Left Atrial Appendage (LAA) dysfunction. Risk of cerebrovascular accident (CVA) is increased approximately 17-fold in patients of MS in Atrial Fibrillation (AF) and is present even in patients of MS in sinus rhythm (SR). This study was undertaken to evaluate the effect of PTMC on LAA function by Trans-esophageal echocardiography (TEE) Doppler and Doppler Tissue Imaging (DTI).

Methods: Total 70 cases were enrolled in this study. Patients with symptomatic severe MS (Mitral Valve Area <1.5cm2), in SR, who underwent a successful PTMC during the period from May 2016 to May 2019 were selected. All the patients underwent Clinical examination, ECG, detailed TTE and TEE before, immediately after (within 24 h) & after 6 months of PTMC.

Results: There was non significant improvement in Left Atrial appendage fractional area change {LAAAC (%)} immediately Post PTMC but there was significant improvement at 6 months Post PTMC. There was significant increase in LAA PW Doppler velocities (LAAEDE, LAALDE and LAAF velocity) immediately Post PTMC which got further improved significantly at 6 months of follow up. There was significant increase in LAA DTI velocities (E, A and S velocity) immediately Post PTMC which got further improved significantly at 6 months of follow up.

Conclusion: PTMC improves left atrial appendage function in patients with mitral stenosis.

Citing Articles

Percutaneous transvenous mitral commissurotomy in rheumatic mitral stenosis with atrial dysfunction. Opening the valve…and a window of opportunity.

Foppa M, Santos A Int J Cardiovasc Imaging. 2024; 38(7):1499-1500.

PMID: 38819546 DOI: 10.1007/s10554-022-02548-5.

Immediate, short-term, and long-term effects of balloon mitral valvuloplasty on the left atrial global longitudinal strain and its correlation to the outcomes in patients with severe rheumatic mitral stenosis.

Setouhi A, Boshra H, Askalany H, Farrag H Egypt Heart J. 2023; 75(1):98.

PMID: 38038813 PMC: 10692051. DOI: 10.1186/s43044-023-00425-7.

Re-intervention percutaneous balloon mitral valvuloplasty in a patient with left atrial appendage thrombus: a case report.

Parikh R, Singh G, Mishra A, Sharma K Eur Heart J Case Rep. 2022; 6(10):ytac374.

PMID: 36225808 PMC: 9547540. DOI: 10.1093/ehjcr/ytac374.

Assessment of the Left Atrial Reservoir Function and Left Atrial Volume After Percutaneous Balloon Mitral Valvuloplasty Using Peak Atrial Longitudinal Strain.

Samrat S, Sofi N, Aggarwal P, Sinha S, Pandey U, Sharma A Cureus. 2022; 14(2):e22395.

PMID: 35371802 PMC: 8938600. DOI: 10.7759/cureus.22395.

References

Karakaya O, Turkmen M, Bitigen A, Saglam M, Barutcu I, Esen A . Effect of percutaneous mitral balloon valvuloplasty on left atrial appendage function: a Doppler tissue study. J Am Soc Echocardiogr. 2006; 19(4):434-7. DOI: 10.1016/j.echo.2005.10.022. View

Porte J, Cormier B, Iung B, Dadez E, Starkman C, Nallet O . Early assessment by transesophageal echocardiography of left atrial appendage function after percutaneous mitral commissurotomy. Am J Cardiol. 1996; 77(1):72-6. DOI: 10.1016/s0002-9149(97)89137-0. View

Ben Farhat M, Ayari M, Maatouk F, Betbout F, Gamra H, Jarra M . Percutaneous balloon versus surgical closed and open mitral commissurotomy: seven-year follow-up results of a randomized trial. Circulation. 1998; 97(3):245-50. DOI: 10.1161/01.cir.97.3.245. View

Tenekecioglu E, Karabulut A, Yilmaz M . Comparison of tissue Doppler dynamics with Doppler flow in evaluating left atrial appendage function by transesophageal echocardiography in prehypertensive and hypertensive patients. Echocardiography. 2010; 27(6):677-86. DOI: 10.1111/j.1540-8175.2009.01102.x. View

Wolf P, Abbott R, Kannel W . Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991; 22(8):983-8. DOI: 10.1161/01.str.22.8.983. View

Ganeswara Reddy V, Rajasekhar D, Vanajakshamma V . Effect of percutaneous mitral balloon valvuloplasty on left atrial appendage function: transesophageal echo study. Indian Heart J. 2012; 64(5):462-8. PMC: 3861092. DOI: 10.1016/j.ihj.2012.07.008. View

Tsang T, Barnes M, Bailey K, Leibson C, Montgomery S, Takemoto Y . Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women. Mayo Clin Proc. 2001; 76(5):467-75. DOI: 10.4065/76.5.467. View

Goswami K, Yadav R, Bahl V . Predictors of left atrial appendage clot: a transesophageal echocardiographic study of left atrial appendage function in patients with severe mitral stenosis. Indian Heart J. 2005; 56(6):628-35. View

Topsakal R, Eryol N, Ozdogru I, Seyfeli E, Abaci A, Oguzhan A . Color Doppler tissue imaging to evaluate left atrial appendage function in patients with mitral stenosis in sinus rhythm. Echocardiography. 2004; 21(3):235-40. DOI: 10.1111/j.0742-2822.2004.03077.x. View

10.

Vijayvergiya R, Sharma R, Shetty R, Subramaniyan A, Karna S, Chongtham D . Effect of percutaneous transvenous mitral commissurotomy on left atrial appendage function: an immediate and 6-month follow-up transesophageal Doppler study. J Am Soc Echocardiogr. 2011; 24(11):1260-7. DOI: 10.1016/j.echo.2011.07.015. View

11.

Pollick C, Taylor D . Assessment of left atrial appendage function by transesophageal echocardiography. Implications for the development of thrombus. Circulation. 1991; 84(1):223-31. DOI: 10.1161/01.cir.84.1.223. View

12.

Tatani S, Campos Filho O, Fischer C, Moises V, Marcondes de Souza J, Alves C . [Functional assessment of the left atrial appendage with transesophageal echocardiography before and after percutaneous valvotomy in the mitral stenosis]. Arq Bras Cardiol. 2005; 84(6):457-60. DOI: 10.1590/s0066-782x2005000600005. View

13.

Bauer F, Verdonck A, Schuster I, Tron C, Eltchaninoff H, Cribier A . Left atrial appendage function analyzed by tissue Doppler imaging in mitral stenosis: effect of afterload reduction after mitral valve commissurotomy. J Am Soc Echocardiogr. 2005; 18(9):934-9. DOI: 10.1016/j.echo.2005.05.014. View

14.

Gurlertop Y, Yilmaz M, Acikel M, Bozkurt E, Erol M, Senocak H . Tissue Doppler properties of the left atrial appendage in patients with mitral valve disease. Echocardiography. 2004; 21(4):319-24. DOI: 10.1111/j.0742-2822.2004.03002.x. View

15.

Daimee M, Salama A, Cherian G, Hayat N, Sugathan T . Left atrial appendage function in mitral stenosis: is a group in sinus rhythm at risk of thromboembolism?. Int J Cardiol. 1998; 66(1):45-54. DOI: 10.1016/s0167-5273(98)00128-4. View

16.

Sahin T, Ural D, Kilic T, Bildirici U, Kozdag G, Agacdiken A . Evaluation of left atrial appendage functions according to different etiologies of atrial fibrillation with a tissue Doppler imaging technique by using transesophageal echocardiography. Echocardiography. 2009; 26(2):171-81. DOI: 10.1111/j.1540-8175.2008.00794.x. View

17.

Bansal M, Kasliwal R . Echocardiography for left atrial appendage structure and function. Indian Heart J. 2012; 64(5):469-75. PMC: 3860699. DOI: 10.1016/j.ihj.2012.07.020. View