Effectiveness of PTMC in Mitral Stenosis after Resolution of Left Atrial Appendage Thrombosis by Oral Anticoagulant.
Background and Aims: Open Surgical Commissurotomy is considered as the only treatment option in presence of a thrombus that contraindicates PTMC. However, this study was designed to see the effectiveness of PTMC after resolution of Left Atrial (LA) Appendage thrombus by anticoagulant (Warfarin and Rivaroxaban ) for 3-6 months .
Methods: It is a prospective observational study of total 12 patients with Rheumatic Mitral Stenosis with LA Appendage thrombus. Out of them, 8 patients underwent PTMC after resolution of thrombus at Cath lab under Department of Cardiology of Chitwan Medical College from July 2019 to March 2020. PA pressure, LA pressure and Aortic pressure were assessed by right heart catheterization by using multipurpose /pigtail catheter whereas mitral valve area and mean mitral valve gradient were assessed by TTE.
Result: Among 12 patients with LA appendage thrombus, 8 patients (66.67%) underwent successful PTMC after complete resolution of thrombus. After the procedure, the mean mitral valve area and mean aortic pressure increased from 0.83±0.2 cm2 to 1.63±0.18 cm2 and from 99.50 ±7.93 mmHg to 106.13±12.25 mmHg respectively. Whereas, mean pressure gradient decreased from 15.88± 4.42 mmHg to 7.13±2.10 mmHg, mean pulmonary artery pressure decreased from 44.13 ±20.85 mmHg to 33.25±19.40 mmHg and mean left atrial pressure decreased from 26.13±6.31 mmHg to 17.38±6.12 mmHg.
Conclusion: This study showed that PTMC in mitral stenosis was successful in those patients whose LA appendage thrombus was resolved by giving oral anticoagulant for 3-6 months without significant MR and tachycardia.
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