RV dysfunction in patients of mitral stenosis and its improvement after BMV

Mukesh Kumar Sharma; Mahesh Narendra Jain; Deepak Ameta; Lekhraj Choudhary

Volume : IX, Issue : VIII, August - 2020

RV dysfunction in patients of mitral stenosis and its improvement after BMV

Mukesh Kumar Sharma, Mahesh Narendra Jain, Deepak Ameta, Lekhraj Choudhary

Abstract :

Background: Rheumatic heart disease (RHD) is one of the most common forms of cardiac diseases, particularly in developing countries.1–3 Mitral stenosis (MS) is the most common valve lesion in chronic RHD. RV function plays an important role in development of clinical symptoms and prognosis in patients with MS.5,8 Our study aim was to assess RV function in these subjects by various echocardiographic parameters pre and post-balloon mitral valvuloplasty (BMV). Methods: Twenty three patients with isolated severe MS in sinus rhythm were assessed for RV function by various echocardiographic and Doppler Tissue Imaging (DTI) parameters before and after BMV (day 1 and 6 months) and also compared with that of thirty two healthy age matched controls. Results: RVMPI (TEI Index), Estimated PASP and LA dimensions was significantly higher in cases than in controls, where as RVFAC, TAPSE, S� and IVA were significantly lower in cases than in controls. Following BMV, on day 1, the MVA increased from 0.95 � 0.21 cm2 to 1.60 � 0.14 cm2 (P<0.001). A significant fall in estimated pulmonary artery systolic pressure (PASP) was seen immediately after BMV from 57.30 � 9.76 mm Hg to 47.22 � 9.34 mm Hg (p < 0.001). A further fall in estimated PASP was observed at 6 months follow-up. Before BMV TAPSE was 17.43 � 3.42 mm which significantly increased to 18.78 � 2.91 mm post BMV (Day1) (p<0.001), and to 19.91 � 2.02 mm after 6 months (p<0.001). RVMPI(TEI Index), S� (Peak systolic velocity at lateral tricuspid annulus) and IVA (Isovolumic Acceleration) were unchanged immediately after BMV. However there was significant improvement in RVMPI(TEI Index), S� and IVA during follow up period of 6 months. Immediate and long term improvement seen in afterload dependant parameters like RVFAC, PA pressure, TAPSE whereas afterload independent parameters like RVMPI, IVA, S� did not improve immediately but significantly improved after 6 months. Conclusion: RV systolic and diastolic function is impaired in patients with severe MS and can be assessed by various two-dimensional echocardiographic and DTI parameters before the appearance of clinical signs of systemic venous congestion. Improvement in RV systolic and diastolic function starts immediately after BMV with reduction in RV afterload (PA pressure) and continues to improve over long term period.