FACTORS RESPONSIBLE FOR INSIGNIFICANT DECREASE IN PULMONARY ARTERY PRESSURE IMMEDIATELY AFTER PER CUTANEOUS TRANS-MITRAL COMMISSUROTOMY IN PATIENTS OF RHEUMATIC MITRAL STENOSIS

Abstract

OBJECTIVES: To determine the factors responsible for insignificant decrease in pulmonary artery pressure immediately after percutaneous trans-mitral commissurotomy (PTMC) in patients of rheumatic mitral stenosis. METHODS: This cross-sectional study was conducted on patients undergoing PTMC at Cardiology Unit, Lady Reading Hospital, Peshawar, Pakistan from 11th February, 2016 to 28th February, 2018. Pulmonary artery pressure (PAP) was noted before and after PTMC through echocardiography. Data was analyzed with SPSS Version 20.0, categorical and continuous variables were described as frequencies/percentages and mean±SD respectively. Odds Ratio was determined for factors negatively affecting the fall in PAP. RESULTS: Out of 159 patients, 108 (67.9%) were females. Mean age was 25.38±10.67 years. PAP was insignificantly decreased in patients >30 years (p>0.05), symptoms for >5 years (p>0.05), left atrium diameter >4.5cm (p>0.05), atrial fibrillation (p>0.05), right ventricle diameter >2.5cm (p>0.05) and NYHA IV dyspnea (p>0.05). Odds Ratio for failure of significant decrease in PAP immediately post-PTMC was 1.68 for age more than 30 years, 1.10 for symptoms more than 5 years, 3.73 for LA diameter more than 4.5 cm, 2.31 for RV diameter more than 2.5 cm , 2.32 for history of atrial fibrillation and 6.71 for NYHA IV dyspnea. CONCLUSION: Factors which negatively affect the immediate fall in PAP post-PTMC are age >30years, duration of symptoms >5years, LA diameter >4.5cm, history of atrial fibrillation, RV diameter >2.5cm and NYHA IV dyspnea and hence are the poor predictors of successful PTMC while NYHA IV dyspnea has highest Odds for insignificant decrease.