الفهرس 
Material and methodsOnly 14 pages are availabe for public view
 |  | from | 147 |  |  |
| | | from | 147 | | |
Abstract
Since, its introduction by Inoue et a1. (1992) in Japan
percutaneous transvenous mitral valvuloplasty (PTMV)became an
established method of treating symptomatic patients with rheumatic
Mitral Stenosis.
It became an attractive alternative to surgical commissurotomy
through shorter hospitalization and avoiding thoractomy.
In most centers Percutaneous transenous mitral valvuloplasty is
performed with fluoroscopic guidance, however, even experienced
operators can be misled by radiographic anatomic landmarks
particularly in cases with very big Right atrium, Left atrium, abnormal
Inter atrial septum or skeletal abnormality (Kyphoscoliosis ... etc.) 2D
Transthoracic echo was a useful adjunct to fluoroscopy during
trans septal cardiac catheterization. However, it was associated with
several disadvantages such as : interruption of the procedure,
interference with sterile techniques a providing inadequate imaging in
some patients.
The use of Transesophageal echocardiography is an important step
before Percutaneous transenous mitral valvuloplasty for : accurate
detection of any Left atrial masses or thrombi, assessment of thickness
and morphology of Inter atrial septum, detection of severity of Mitral
”””1”’”11I”’”’0._””,””,””””11I11I11I11I””’”””0”1””11I””1””00”””’’”””1”.,””’”’.”.’”’_10” ”’.0.’””1”(3”’”””
IIIIIIIIIIIIIIIIIIIIIOIIUOIOIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII11I11111I111I11111111111I11I1I11111111111111I1111111111I1111I11I11I1111 fjJ~ 111111I11I1111111
regurge, proper study of valve morphology and Mitral valve scoring.
In our work we compared between two categortes of patients undergoing
Percutaneous transenous mitral valvuloplasty for symptomatic Mitral
stenosis.
25 patients did the procedure under fluorscopic guidance (control
group) and 25 patients did the procedure with on-line Transesophageal
echocardiography guidance (trial group).
The patients (both trial and control) were selected based on clinical
and echo criteria :
1. New York heart Association functional class III or N.
2. Moderate or severe Mitral stenosis Mitral valve area < 1.3 cm2.
3. Mitral regurge Grade < II/N.
Some patients were excluded from the trial :
1. Patients with large or mobile Left atrial thrombus or thrombus
near the mouth of Left atrial appendage.
2. Patients to which Transesophageal echocardiography may be
risky or difficult (pharyngo-esophageal lesions - ... short stature
... bleeding tendencies ... irritability).
3. Very old or critically ill patients.
IUIIIIIIIIIIIIIIIIIII011II1IIIIHIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII181111111111111101111111111IIIIllllllllllllllllillUIIIIIIIIUllIIHIIIlIIHlIIIHIIIIIIlIIIIIIIIII !]J~ 111I111I811I1111
In the trial group despite being a small number: it has been clearly
proved that on-line Transesophageal echocardiography guidance was
of value :
in guidance of atrial Septostomy giving more help in septal
puncture Inthe proper site (thus a successful procedure wih shorter
time) proper balloon positioning and dilatation and early detection of
complication (Mitral regurge, Atrial septal defect. tamponade).
immediate assessment of results thus deciding when to stop dilatation
achieving the desired degree of dilatation and commissural splitting
(which were easily detected at once after each balloon inflation by
Transesophageal echocardiography guidance) or because of increasing
Mitral regurge or any other complication. It was obvious that the total
procedure time. fluoro time and incidence of severe complication were
less in the trial group.
The operator convenience was fair and the patient (well sedated)
convenience was as the usual Transesophageal echocardtography
procedure pre-balloon.
On-line Transesophageal echocardiography guidance was of special
value in case with big Left atrium. Right atrium or thick or abnormal
septum.