Outcomes of Aortic Regurgitation After Percutaneous Transmitral Commissurotomy: Prospective Cohort

Abstract

PURPOSE: The combined mitral stenosis (MS) and aortic regurgitation (AR) impose opposite  loading conditions on the left ventricle. Physiologically, the relief of MS may increase the severity  of AR.  METHODS: Participants were Filipinos 19 years or older, admitted because of severe MS with  mild to moderate AR. The outcome of percutaneous transmitral commissurotomy (PTMC) was  divided into two groups: (1) significant AR that included the increase in severity of AR: mild to moderate/severe or moderate to severe AR, and (2) the insignificant AR group, which included  any decrease in the severity of AR: moderate to mild or persistence of mild or moderate AR.  These groups were compared from baseline, 24 hours, 1 month, and 6 months using the same  echocardiographic parameters. The numerical data between significant and insignificant tricuspid  regurgitation were compared using nonparametric Mann-Whitney U test and categorical data  using the χ2 test.  RESULTS: A total of 43 participants were analyzed. At 24 hours post-PTMC, the significant AR  group had significantly lower left ventricular end-diastolic dimension (3.83 vs 4.5, P = 0.008), left  ventricular end-systolic dimension (2.33 vs 2.97, P = 0.017), right ventricular fraction area change  (38.6 vs 48.7, P = 0.025), and left ventricular outflow tract (1.66 vs 2.02, P = 0.020) and higher  systolic pulmonary arterial pressure (57 vs 32.4, P = 0.008). At 1 and 6 months, there were no  significant differences in echocardiographic parameters between the significant and insignificant  AR groups’ left ventricular end-diastolic dimension (4.58 vs 4.5, 4.64 vs 4.57), left ventricular  end-systolic dimension (3.1 vs 2.9, 2.9 vs 2.91), and systolic pulmonary arterial pressure (28  vs 34.7, 33.8 vs 32.4). Those with significant AR had a higher mean Wilkin score (mean, 10;  P = 0.007) and subvalvular thickening (mean, 2.6; P = 0.005).  CONCLUSION: On short-term follow-up, the presence of mild to moderate AR before PTMC  does not lead to severe AR. The outcomes regardless of the group showed a good functional  class and no significant echocardiographic differences when compared.  KEYWORDS: rheumatic heart disease, mitral stenosis, percutaneous transmitral  commissurotomy