PTMC - Percutaneous Transvenous Mitral Commissurotomy
The procedure used to treat mitral valve stenosis is known as Percutaneous Trans-Mitral Commissurotomy. Mitral stenosis is a condition where the mitral valve in the heart is thickened due to infection with bacteria- Beta Hemolytic Streptococci in childhood. The valvular thickening induces a progressive obstruction to blood flow which results in breathing difficulty, arrhythmia and clot formation leading to paralysis or stroke. The stenotic mitral valve can be treated with valve replacement surgery or clearing the stenosis using a balloon in the PTMC procedure. However, surgical valve implantation should be avoided as the condition necessitates the use of anti-coagulants for the rest of the life with a life threatening risk of bleeding in accidents or trauma. Additionally the other risk is the formation of blocks in the valve if the medications were not regularly taken. Hence PTMC is advantageous over open heart surgery.
- Patients with mitral valve stenosis and showing symptoms
- Older patients having aortic valve stenosis, but cannot undergo surgery
- Some patients with pulmonic valve stenosis
- Complete blood tests, electrocardiogram, chest x-ray will be done a day before the procedure.
- Regular medications such as anti hypertensives and anti diabetics should be informed to the doctor and suggestions have to be taken to adjust them on the day of the test.
- Anti-coagulants are administered in some patients on surgeon’s advice before the procedure.
- Eating and drinking should not be done after evening on the day before the procedure.
- Allergic reaction to any previous medication should be informed.
- A detailed functional disability and Echo Doppler study should be done in patients 24- 48 hrs of PTMC procedure.
- The Inoue balloon with single self position will be used for the commissurotomy procedure.
- The dilating diameter of the balloon has an upper limit which will be chosen according to the patient’s body weight.
- The procedure will be performed with all the precautions with inflation of the balloon to atleast 2 mm which is less than the maximum diameter.
- The diameter of the balloon will be increased and the procedure will be repeated in case the results were suboptimal.
- If the hemodynamic parameters are optimal then the balloons tip will be traversed through the intra atrial septum with a stiffed canula which facilitates the passage of balloon in to the left atrium.
- Through the left atrium the balloon will be placed into the left ventricle.
- The balloon will be inflated with diluted contrast material till the waist of the balloon will be invisible.
- The hemodynamic measurements will be repeated after the PTMC procedure.
- An echo Doppler study will be conducted after 24 h after the procedure through transthoracic or transesophageal echocardiography.
- Wilkins score will be used to evaluate the valve morphology.
- The patient will feel tired and have pain for the first few weeks post surgery. Some short and sharp pains will appear on either side of your chest. The chest area, shoulders and upper back may ache for some days. The incision on chest gives some soreness and may swell which will be improved in 4-6 weeks.
- The patient will able to perform usual activities after 4 to 6 weeks of the procedure. For at least 6 weeks heavy weight lifting should be avoided that may strain the chest muscles and need to rest very often.
- The procedure usually repairs the mitral valve but it is still very important to eat a heart healthy diet, quit smoking and reduce stress. Heart medicines should be taken regularly.
- Sometimes cardiac rehabilitation will help the patient to recover fast.
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