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Submitted: 16 May 2007 Modified: 26 October 2017
HERDIN Record #: PCHRDPC011198

Commissural morphology as a determinant of outcome after percutaneous transeptal mitral commissurotomy: Validation of a new echocardiographic scoring system.

Antonio C. Pascual,
Raul D. Jara,
Romeo J. Santos,
Viannely Berwin Flores ,
 Lacson SMA

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Percutaneous transeptal mitral commissurotomy (PTMC) is an effective technique in relieving rheumatic mitral stenosis, with minimal mortality and acceptable complication rates. A semi-quantitative echocardiographic scoring system put forth by Wilkins and Placios, defining the morphologic features of the stenotic valvar and subvalvar apparatus, is widely used, however, contrasting views were reported and controversy still exists about this criteria for determining suitability of individual patients for PTMC. Between January 1989 and December 1997, 425 patients were included in the analysis. Two hundred and sixty nine patients (637) had succesful PTMC (group I) whereas 156 patients (37%) achieved suboptimal dilation of the mitral valve (Group II). The study population consisted of 324 women (76.2%) and 101 men (23.8%) with a mean age of 34.5 years (range, 18 to 67 years). Fourteen (3.3%) patients in NYHA FC 1,335 (78.8%) in class II, 66(15.5%) in class III, and 10 (2.4%) in class IV. There were 295 (69.4%) patients in sinus rhythm (SR) whereas 130 (30.6%) patients were in atrial fibrillation (AF) or atrial flutter. In all patients, the mean weight is 48.9 kgs. (range, 30 to 85 kgs.) and the mean height is 157.4 cm (Range, 133 to 191 cms.) Pre-PTMC, the mean mitral valve gradient (MVG) is 15.9 mm Hg, the MVA by pressure half time (PHT) and planimetry (PLN) is 0.76 cm2, while mitral regugitation is 4.3% (MR jet area to LA area ratio). Clinical and echocardiographic data between the 2 groups were given in table 1, table 2, and table 3. There were significant differences between the patients with good result after PTMC (Group I) and those with suboptimal mitral valve area after PTMC (group II). Patients in group II at baseline had a significantly higher percentage of higher percentage of higher functional classification, and a higher percentage of atrial fibrillation. There were no significant differences in age, sex distribution, height and weight between the 2 groups. The total Wilkins echocardiographic score was 6.98 for group I and 7.34 for group II. The cut-off point was set to an echocadiographic score of 7. The sensitivity of an echocardiographic score of 7 or less for predicting a good outcome is 57%, and the specificity was 52%. The positive predictive value (echocardiographic score 7) indicating an optimal MVA post-PTMC is 67% and the negative predictive value (echocardiographic score 7) indicating suboptimal outcome is 41%. Using the new scoring index, the total echocardiographic score was 7.88 for group I and 8.42 for group II. The cut-off point as set at an echocardiographic score of 8 . The sensitivity of an echocardiographic score of 8 or less for predicting a good outcome is 74%, and the specificity is 55%. The positive predictive value (echocardiographic score of 8) indicating an optimal MVA post-PTMC is 74%, and the negative predictive alue (echocardiographic score 8) indicating suboptimal outcome is 55%. An echocardiographic score of 8 or less, based on the new criteria has significant commissural calcification and subvalvular involvement are the most important morphologic criteria contributory to the success rate of PTMC.

Publication Type
Publication Sub Type
Journal Article, Original
Philippine Journal of Cardiology
Publication Date
July-September 1999
LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Library Box No.44 Fulltext pdf (Request Document)
Philippine Council for Health and Research Development Fulltext Print Format (Request Document)
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