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To identify clinical, echocardiographic, and hemodynamic parameters which can predict persistent PH after PMC, and also to determine the impact of persistent PH on the clinical outcomes.
Pure mitral Stenosis develops in approximately 40% of all patients with rheumatic heart disease, and is frequently complicated by Pulmonary hypertension (PH). Pulmonary hypertension influences symptomatology and long-term prognosis. Percutaneous Mitral Commissurotomy (PMC), was first described in 1984, has good results and is performed by antegrade access to the mitral valve through trans-septal puncture by one of various techniques (e.g. Inuoe, and multitrack system). Pulmonary artery pressures (PAP) decrease following PMC. The improvement in pulmonary hypertension after PMC is explained by the improvement in the mitral valve area and subsequent decompression of left atrium (LA) and pulmonary venous beds. Even though there have been studies showing excellent results following PMC in all grades of PH, nonregression of PH following PMC is not uncommon. The component of PAP contributed by the passive transmission of the elevated LA pressure regresses immediately after a successful PMC proportional to the reduction in transmitral gradient. The PH contributed by pulmonary arteriolar constriction slowly comes down over weeks or a few months, But a "fixed" component due to pulmonary vascular disease usually persists.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patients with persistent pulmonary hypertension | Active Comparator | Patients with persistent pulmonary hypertension after balloon mitral comisseruotomy |
|
| Patients without persistent pulmonary hypertension | Active Comparator | Patients without persistent pulmonary hypertension after balloon mitral comisseruotomy |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Percutaneous Mitral Commissurotomy | Procedure | Percutaneous mitral commissurotomy is performed by experienced interventional cardiologists using the Inoue balloon or multitrack technique. During the procedure, conventional hemodynamic parameters are monitored. A successful immediate result is defined as a mitral valve area > 1.5 square cm with less than moderate to severe mitral regurgitation. |
| Measure | Description | Time Frame |
|---|---|---|
| Composite of cardiovascular event | Composite of cardiovascular mortality, cerebral infarction, systemic embolic events ,RV failure ,MV re stenosis that occurred during follow-up, and PMC-related complications; procedural mortality and urgent MV surgery. parameters changes from base line study and after follow up as MVA in cm 2,PASP in mmHg,LAP in mmHg,LVEP in mmHg,PVR in wood unit | Participants will be followed for a minimum follow-up of one month |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mohamed abdelfatah Ahmed | Contact | +2001121560152 | drmohamedabdelfatah@yahoo.com | |
| Amr Elbadry ibrahim | Contact | +2001060701601 | aelbadry@aun.edu.eg |
| Name | Affiliation | Role |
|---|---|---|
| mohamed Abdelghany Koreim | Assiut University, 71515 Assiut, Egypt. | Principal Investigator |
| Hosam Hasan El Araby | Assiut University, 71515 Assiut, Egypt. | Study Director |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 21214093 | Background | Hart SA, Krasuski RA, Wang A, Kisslo K, Harrison JK, Bashore TM. Pulmonary hypertension and elevated transpulmonary gradient in patients with mitral stenosis. J Heart Valve Dis. 2010 Nov;19(6):708-15. | |
| 19208309 | Background | Noor A, Saghir T, Zaman KS. Determinants of decrease in pulmonary hypertension following percutaneous transvenous mitral commissurotomy. J Coll Physicians Surg Pak. 2009 Feb;19(2):81-5. |
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| ID | Term |
|---|---|
| D006976 | Hypertension, Pulmonary |
| ID | Term |
|---|---|
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D006973 | Hypertension |
| D014652 | Vascular Diseases |
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predictors of Persistent Pulmonary Hypertension After Percutaneous Mitral Commissurotomy
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percutaneous mitral commissurotomy
|
|
| Amr ElBadry Ibrahim |
| Assiut University, 71515 Assiut, Egypt. |
| Principal Investigator |
| 8542626 | Background | Bahl VK, Chandra S, Talwar KK, Kaul U, Sharma S, Wasir HS. Balloon mitral valvotomy in patients with systemic and suprasystemic pulmonary artery pressures. Cathet Cardiovasc Diagn. 1995 Nov;36(3):211-5. doi: 10.1002/ccd.1810360304. |
| 18980082 | Background | Fawzy ME, Osman A, Nambiar V, Nowayhed O, El DA, Badr A, Canver CC. Immediate and long-term results of mitral balloon valvuloplasty in patients with severe pulmonary hypertension. J Heart Valve Dis. 2008 Sep;17(5):485-91. |
| D002318 |
| Cardiovascular Diseases |