Impact of percutaneous balloon mitral valvuloplasty on right and left ventricular functions assessed by tissue Doppler imaging

ABSTRACT

Pure mitral stenosis affect left ventricular performance as a result of myocardial and mechanical factors. It has been found that, with increase in pulmonary artery pressure, the right ventricle may hypertrophy and dilate, and right ventricular ejection fraction decreases. Pulsed TDI has been used for the evaluation of impaired systolic or diastolic function. Percutaneous mitral valvotomy has proven to be effective technique for the relief of obstruction in patients with mitral stenosis. However, the results of the studies about the effect of percutaneous mitral balloon valvuloplasty [PMBV] on ventricular functions are controversial. Of this study was to assess right and left ventricular functions using Doppler tissue imaging [DTI] before and after percutaneous mitral valvuloplasty two days after and at 3 months follow up. We studied 30 selected thirty patients with symptomatic mitral stenosis of rheumatic etiology, who were admitted for percutaneous mitral valvuloplasty and another twenty normal disease free subjects, as proved by electrocardiography ECG and Doppler-echocardiography, thirteen were females and seven were males. All patients were subjected to history analysis, clinical examination, ECG analysis, transthoracic echo Doppler study to asses mitral valve area and trans mitral diastolic gradient, transoesophageal echo study to exclude left atrial cavity or appendage thrombi and lastly pulsed TDI to asses right and left ventricular functions one day before and two days after percutaneous mitral valvuloplasty and then repeat at 3 months follow up. Significant increase in mitral valve area, drop of transmitral pressure gradient and increase of left and right venticular ejection fraction two days and 3 months after the procedure [p <0.05]. By TDI all the myocardial velocities significantly increased after PMV but still below the normal values of the control group [p < 0.05]. PMV results in significant improvement of systolic myocardial velocities of right and left ventricles two after and at follow up, but these velocities are still below the normal values