Persistent Pulmonary Hypertension After Percutaneous Mitral Commissurotomy
Persistent Pulmonary Hypertension After Percutaneous Mitral Commissurotomy
To identify clinical, echocardiographic, and hemodynamic parameters which can predict
 persistent PH after PMC, and also to determine the impact of persistent PH on the clinical
 outcomes.
Pure mitral Stenosis develops in approximately 40% of all patients with rheumatic heart
 disease, and is frequently complicated by Pulmonary hypertension (PH). Pulmonary hypertension
 influences symptomatology and long-term prognosis. Percutaneous Mitral Commissurotomy (PMC),
 was first described in 1984, has good results and is performed by antegrade access to the
 mitral valve through trans-septal puncture by one of various techniques (e.g. Inuoe, and
 multitrack system). Pulmonary artery pressures (PAP) decrease following PMC. The improvement
 in pulmonary hypertension after PMC is explained by the improvement in the mitral valve area
 and subsequent decompression of left atrium (LA) and pulmonary venous beds. Even though there
 have been studies showing excellent results following PMC in all grades of PH, nonregression
 of PH following PMC is not uncommon. The component of PAP contributed by the passive
 transmission of the elevated LA pressure regresses immediately after a successful PMC
 proportional to the reduction in transmitral gradient. The PH contributed by pulmonary
 arteriolar constriction slowly comes down over weeks or a few months, But a "fixed" component
 due to pulmonary vascular disease usually persists.
Inclusion Criteria:

 -  Severe mitral stenosis (mitral valve area ≤1.5cm).

 -  Significant dyspnea.

 -  Favorable anatomical characteristics for PMC as assessed by transthoracic
 echocardiography

 Exclusion Criteria:

 -  Significant mitral regurgitation (≥ grade II/IV). Bilateral commissural calcification.

 -  Presence of other lesions which need open heart surgery.

 -  Wilkins' score > 12.

 -  Persistent LA thrombus despite adequate anticoagulation.

 -  End stage renal or liver disease.

 -  Patients with severe COPD and other chest problems that might be complicated by
 pulmonary hypertension per se.