Update on percutaneous mitral commissurotomy
| Autor: | Lucas Lodi-Junqueira, Bruno Ramos Nascimento, Judy Hung, Maria do Carmo Pereira Nunes, Guilherme Rafael Sant'Anna Athayde, Timothy C. Tan |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Reoperation
medicine.medical_specialty Percutaneous Population Long Term Adverse Effects 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Mitral valve stenosis Mitral valve Internal medicine medicine.artery Outcome Assessment Health Care Epidemiology Humans Mitral Valve Stenosis Medicine 030212 general & internal medicine Cardiac Surgical Procedures education Mitral regurgitation education.field_of_study business.industry Rheumatic Heart Disease medicine.disease Surgery medicine.anatomical_structure Echocardiography Pulmonary artery Cardiology Mitral Valve Cardiology and Cardiovascular Medicine business |
| Zdroj: | Heart. 102:500-507 |
| ISSN: | 1468-201X 1355-6037 |
| DOI: | 10.1136/heartjnl-2015-308091 |
| Popis: | Percutaneous mitral commissurotomy (PMC) is the first-line therapy for managing rheumatic mitral stenosis. Over the past two decades, the indications of the procedure have expanded to include patients with unfavourable valve anatomy as a consequence of epidemiological changes in patient population. The procedure is increasingly being performed in patients with increased age, more deformed valves and associated comorbidities. Echocardiography plays a crucial role in patient selection and to guide a more efficient procedure. The main echocardiographic predictors of immediate results after PMC are mitral valve area, subvalvular thickening and valve calcification, especially at the commissural level. However, procedural success rate is not only dependent on valve anatomy, but a number of other factors including patient characteristics, interventional management strategies and operator expertise. Severe mitral regurgitation continues to be the most common immediate procedural complication with unchanged incidence rates over time. The long-term outcome after PMC is mainly determined by the immediate procedural results. Postprocedural parameters associated with late adverse events include mitral valve area, mitral regurgitation severity, mean gradient and pulmonary artery pressure. Mitral restenosis is an important predictor of event-free survival rates after successful PMC, and repeat procedure can be considered in cases with commissural refusion. PMC can be performed in special situations, which include high-risk patients, during pregnancy and in the presence of left atrial thrombus, especially in centres with specialised expertise. Therefore, procedural decision-making should take into account the several determinant factors of PMC outcomes. This paper provides an overview and update of PMC techniques, complications, immediate and long-term results over time, and assessment of suitability for the procedure. |
| Databáze: | OpenAIRE |
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