OPTIMIZING OUTCOMES IN PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY

In developing countries rheumatic heart disease (RHD) still awaits to be eliminated. It remains as is one of the leading causes of cardiac morbidity and mortality. Mitral valve is the most frequently afflicted valve in rheumatic heart 2 disease. Mitral valve area reduces to 1.5cm(2) it should be considered as severs and intervention should be planned early. Trans Esophageal echocardiography (TEE) offers unrestricted access to evaluate appendage and should be performed in all patients being considered for intervention. Symptoms of Mitral Stenosis can be effectively mitigated by controlling heart rate regardless of patient being in sinus rhythm or atrial fibrillation. Percutaneous transvenous mitral commissurotomy (PTMC) is safe, effective and durable procedure. Careful selection of valves and patients - Intervene early - low Wilkins Score. All patients must be screened for LA/LAA thrombus. It is a patient friendly procedure. Patients who derive maximal benefit are young, females, pregnant, those who require repeat procedure after CMV or PTMC and those who have contra indications to general anesthesia. It has documented salutary acute and long term results. One has to have supervised training to learn to avoid complications. LV function may be compromised therefore LV function shall be monitor diligently.