Mitral leaflet separation index
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This study assessed the severity of mitral stenosis before and after percutaneous transvenous mitral commissurotomy (PTMC) using the mitral leaflet separation (MLS) index. 275 patients undergoing PTMC were evaluated clinically and via echocardiography before and after the procedure. Before PTMC, a good correlation was observed between mitral valve area (MVA) measurements and MLS index. Post-PTMC, MVA increased significantly while MLS index also increased and continued to correlate well with MVA. The study concludes that MLS index can be used as a complementary method to assess mitral stenosis severity both before and after PTMC.
Mitral leaflet separation index
- 1. Assessment of Severity of Mitral Stenosis before and after Percutaneous Transvenous Mitral Commissurotomy by Using Mitral Leaflet Separation Index Dr. Md.Toufiqur Rahman MBBS, FCPS, MD, FACC, FESC, FRCPE, FAHA, FSCAI, FAPSC, FAPSIC DEPARTMENT of CARDIOLOGY, NATIONAL INSTITUTE OF CARDIOVASCULAR DISEASES, DHAKA, BANGLADESH
- 2. INTRODUCTION
- 3. INTRODUCTION • Rheumatic fever and rheumatic heart disease continue to be the major health problem in all developing countries including Bangladesh. • Rheumatic mitral stenosis is a very common problem in our population having an incidence of 54 percent among rheumatic heart disease with a female preponderance of 2:1. Cont…
- 4. INTRODUCTION • Percutaneous balloon mitral commissurotomy (PTMC) is appealing because the mechanism of valve dilation closely parallels the mechanism of surgical mitral commissurotomy. • Mitral leaflet separation (MLS) index is a novel method to assess the severity of mitral stenosis.
- 5. OBJECTIVES
- 6. OBJECTIVES The aim of this study is to correlate the MLS index with 2D echo planimetry method and Doppler PHT method in patients undergoing PTMC.
- 7. METHODS
- 8. METHODS • A prospective study was done in National Institute of Cardiovascular Diseases, Dhaka, Bangladesh, Al- Helal Heart Institute, Mirpur, Dhaka and Uro- Bangla Heart Hospital, Lalmatia, Dhaka during the period of August 2006 to June 2012. • Two hundred and seventy five (275) patients with rheumatic mitral stenosis who underwent PTMC were evaluated clinically , by echocardiography and by catheter during and after procedure. Cont…
- 9. METHODS • The severity of Mitral Stenosis was assessed using 2D mitral valve area; pressure half time and MLS index. • The MLS index was estimated by measuring the maximal separation of tip of the mitral leaflets in end-diastole in PLAX view and in apical 4-chamber view (A4C view).
- 10. RESULTS
- 11. Table 1 Variable Values Age ( years ) 23.51 ± 13.22 Female gender (n) 228 (83.0 %) Height (cm) 165.2 ± 5.7 Weight (kg) 61.1 ± 4.6 Body surface area (m2 ) 1.69 ± 0.4 Body mass index (kg/m2 ) 22.77 ± 2.3 Heart rate (bpm) 74.5 ± 8.7 Systolic blood pressure (mm Hg) 111 ± 13 Diastolic blood pressure(mm Hg) 72 ± 09 End-diastolic LV diameter (mm) 45.3 ± 3.9 End-systolic LV diameter (mm) 29.4 ± 4.2 LV ejection fraction- Simpson”s (%) 62.4 ± 3.9 LV ejection fraction- Teicholz (%) 62.8 ± 4.1
- 12. Table 2 Parameters Before PTMC N=275 After PTMC1day N=275 P Value MVA (cm2 )(2D Planometry) 0.83 ± 0.14 1.69 ± 0.39 <0.0001 MVA (cm2 )(PHT method) 0.80 ± 0.35 1.62 ± 0.39 <0.0001 Mitral Leaflet Separation Index (MLSI) mm 5.97 11.24 <0.0001 Transmitral gradient (mmHg) 26.23 ± 02.12 11.73± 03.94 <0.0001 LA size (mm) 48.27 ± 4.13 30.25 ± 3.32 <0.0001 LA Pressure (mmHg) 42 ±05 18±03 <0.0001 Aortic Pressure (mmHg) 88±12 98 ±11 <0.0001
- 13. Table 3 Correlation Co efficient (r) P value Between MVA(2D) and MLSI 0.36 0.0132 Between MVA(PHT) and MLSI 0.54 0.0001 MVA: Mitral Valve Area; MLSI: Mitral Leaflet Separation Index Correlation between MVA(2D), MVA(PHT) and MLSI-before PTMC
- 14. Table 4 Correlation between MVA(2D), MVA(PHT) and MLSI-after PTMC Correlation Co efficient (r) P value Between MVA(2D) and MLSI 0.39 0.0084 Between MVA(PHT) and MLSI 0.15 0.27 MVA: Mitral Valve Area; MLSI: Mitral Leaflet Separation Index
- 15. RESULTS Mean age of the study population was 23.51 ± 13.22 years. Most of the population are female (83%). After PTMC mean mitral valve area increased from 0.83 ± 0.14 cm2 to 1.69 ± 0.39 cm2 as measured by echocardiography(2D Planometry). Pre-PTMC, mean MVA (PHT) was 0.80 ± 0.35 cm2 and MLS index was 5.97 mm. A good correlation was observed between MVA (2D) and MLSI (r = 0.36, p= 0.0132) and also between MVA (PHT) and MLSI (r = 0.54, p = 0.0001).
- 16. RESULTS Post-PTMC, mean MVA (PHT) was 1.62 ± 0.39 cm2 and MLSI was 11.24 mm. Here also, a good correlation was observed between MLSI and MVA (2D) (r = 0.39, p = 0.0084); however, a poor correlation was observed between MLSI and MVA (PHT) (r = 0.15, p = 0.27).
- 17. CONCLUSION
- 18. CONCLUSION MLSI can be used as a complementary method for the assessment of Mitral Stenosis severity before as well as after PTMC.
- 19. Disclosure of Interest: None Declared
- 20. Address of correspondence: Dr. Md. Toufiqur Rahman, Email:drtoufiq19711@yahoo.com: drtoufiq1971@gmail.com