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Original ArticleOpen Access
Percutaneous Transvenous Mitral Commissurotomy : Hemodynamic and Initial Outcome Differences Between Atrial Fibrillation and Sinus Rhythm in Rheumatic Mitral Stenosis Patients
Srimahachota S 
,
Boonyaratavej S ,
Wannakrairoj M ,
Udayachalerm W ,
Sangwattanaroj S ,
Ngarmukos P ,
Chayanont D
,
Boonyaratavej S ,
Wannakrairoj M ,
Udayachalerm W ,
Sangwattanaroj S ,
Ngarmukos P ,
Chayanont D SMONPORN BOONYARATAVEJ, M.D.*,
WASAN UDAYACHALERM,M.D.*,
PUNGCHAI NGARMUKOS, M.D.*
Background
: Atrial fibrillation (AF) occurs frequently in severe rheumatic mitral stenosis
(MS) and has been reported to be a predictor of poor outcome after percutaneous transvenous
mitral commissurotomy (PTMC). Nevertheless, according to observations in our catheterization
laboratory, patients with sinus rhythm (SR) seem to have a higher pulmonary artery pressure than
AF.
Purpose
: To determine 1) the hemodynamic differences between MS patients with AF
and SR before and after PTMC and 2) the success rate and difference in outcome between both
groups.
Method
: A total of 145 patients who had undergone PTMC with the Inoue balloon tech-
nique in King Chulalongkorn Memorial Hospital between 1993 and 1997 were enrolkd. The data
were presented as mean
เธ‘
SD. Student t-test was used to compare the difference in hemodynamic
and outcome between the AF and SR groups.
Results
: Fifty-six patients (38.6%) were in the AF group. The AF patients were older
(42.0
เธ‘
11.3
vs
32.4
เธ‘
8.7 yr., p
<
0.0001), had a larger left atrium (49.2
เธ‘
6.1
vs
45.3
เธ‘
4.9
mm, p
<
0.001) and a higher valvular calcification score (1.8
เธ‘
0.6
vs
1.5
เธ‘
0.6, p
=
0.02) than the
SR group. There was no significant difference between baseline heart rate and overall MY score
index. The hemodynamic data showed that the SR group had higher systolic (59.9
เธ‘
26.0
vs
47.4
เธ‘
16.8 mmHg, p
<
0.05), diastolic (28.1
เธ‘
12.8
vs
22.7
เธ‘
9.2 mm Hg, p
<
0.05) and mean (40.1
เธ‘
17.1
vs
32.7
เธ‘
11.8 mmHg, p
<
0.05) pulmonary artery (PA) pressure than the AF group. After
successful PTMC, the SR group exhibited a more favorable change in all PA pressures and the
transmitral valvular gradient (10.0
เธ‘
6.5
vs
6.7
เธ‘
6.5 mmHg, p
<
0.01) than the AF group. Pro-
cedural success rates were 98 per cent in the AF and 96 per cent in the SR group (p
=
ns).
Transthoracic colour-flow echocardiographic imaging detected atrial septal defects in 18.2 per
cent and 7.5 per cent (p
=
0.08) of the AF and SR groups, respectively. There was no systemic
embolization, peri-procedural death or emergency surgery in both groups.
Vo1.84 No.5
PTMC : HEMODYNAMIC AND OUTCOME DIFFERENCES
675
Conclusion : Patients with MS and AF were older, had a larger LA and lower pre-
P1MC PA pressure than the patients who had MS and SR. In addition, patients with SR had a
more favourable PA and LA pressure reduction than patients with AF.
Key word : Percutaneous Transvenous Mitral Commissurotomy, Atrial Fibrillation, Sinus Rhythm
WASAN UDAYACHALERM,M.D.*,
PUNGCHAI NGARMUKOS, M.D.*
Background
: Atrial fibrillation (AF) occurs frequently in severe rheumatic mitral stenosis
(MS) and has been reported to be a predictor of poor outcome after percutaneous transvenous
mitral commissurotomy (PTMC). Nevertheless, according to observations in our catheterization
laboratory, patients with sinus rhythm (SR) seem to have a higher pulmonary artery pressure than
AF.
Purpose
: To determine 1) the hemodynamic differences between MS patients with AF
and SR before and after PTMC and 2) the success rate and difference in outcome between both
groups.
Method
: A total of 145 patients who had undergone PTMC with the Inoue balloon tech-
nique in King Chulalongkorn Memorial Hospital between 1993 and 1997 were enrolkd. The data
were presented as mean
เธ‘
SD. Student t-test was used to compare the difference in hemodynamic
and outcome between the AF and SR groups.
Results
: Fifty-six patients (38.6%) were in the AF group. The AF patients were older
(42.0
เธ‘
11.3
vs
32.4
เธ‘
8.7 yr., p
<
0.0001), had a larger left atrium (49.2
เธ‘
6.1
vs
45.3
เธ‘
4.9
mm, p
<
0.001) and a higher valvular calcification score (1.8
เธ‘
0.6
vs
1.5
เธ‘
0.6, p
=
0.02) than the
SR group. There was no significant difference between baseline heart rate and overall MY score
index. The hemodynamic data showed that the SR group had higher systolic (59.9
เธ‘
26.0
vs
47.4
เธ‘
16.8 mmHg, p
<
0.05), diastolic (28.1
เธ‘
12.8
vs
22.7
เธ‘
9.2 mm Hg, p
<
0.05) and mean (40.1
เธ‘
17.1
vs
32.7
เธ‘
11.8 mmHg, p
<
0.05) pulmonary artery (PA) pressure than the AF group. After
successful PTMC, the SR group exhibited a more favorable change in all PA pressures and the
transmitral valvular gradient (10.0
เธ‘
6.5
vs
6.7
เธ‘
6.5 mmHg, p
<
0.01) than the AF group. Pro-
cedural success rates were 98 per cent in the AF and 96 per cent in the SR group (p
=
ns).
Transthoracic colour-flow echocardiographic imaging detected atrial septal defects in 18.2 per
cent and 7.5 per cent (p
=
0.08) of the AF and SR groups, respectively. There was no systemic
embolization, peri-procedural death or emergency surgery in both groups.
Vo1.84 No.5
PTMC : HEMODYNAMIC AND OUTCOME DIFFERENCES
675
Conclusion : Patients with MS and AF were older, had a larger LA and lower pre-
P1MC PA pressure than the patients who had MS and SR. In addition, patients with SR had a
more favourable PA and LA pressure reduction than patients with AF.
Key word : Percutaneous Transvenous Mitral Commissurotomy, Atrial Fibrillation, Sinus Rhythm
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