.. Background: Mitral stenosis is one of the grave consequences of rheumatic heart disease. Balloon valvuloplasty for stenosed mitral and pulmonary valves has been practiced with good results in the world. Since Inoue et al. introduced balloon valvuloplasty in 1982, percutaneous transmitral commissurotomy (PTMC) has become the treatment of choice for mitral stenosis replacing surgical commissurotomy and mitral valve replacement in many cases. Objective: The aim of this study was to audit the procedural success, in hospital outcome in patients undergoing percutaneous trans-mitral balloon commissurotomy (PTMC) in our set up. Study Design: Observational cross sectional study. Place and Duration: The study was conducted at Faisalabad Institute of Cardiology Faisalabad from March 2011 to December 2013. Materials and Methods: Total one hundred and twenty four patients underwent percutaneous transmitral commissurotomy from March 2011 to December 2013. Any patient of age ≥ 10 years with mitral stenosis who fulfills the inclusion and exclusion criteria for PTMC was enrolled in this study. A full history particularly, age, sex, occupation, address, symptoms regarding their referral for medical checkup was noted. Detailed clinical examination especially relevant cardiovascular examination of all the patients was done. ECG of every patient was done. Baseline routine investigations including blood complete with ESR, electrolytes, CRP, LFT, RFT was done in each case. A baseline echocardiography was performed in all patients. Mitral valve area was calculated by planimetry and by pressure half time method. Severity of mitral stenosis was graded as: very sever stenosis (valve area <1cm2), severe (valve area 11.5 cm 2) moderate (valve area 1.52 cm2) and mild (valve area > 2.0 cm2). To exclude any clot in LA and LA appendage Transesophageal echocardiography (TEE) was performed. In Cath Lab pre and post PTMC invasive hemodynamics including LA, RA, RV, left ventricular end-diastolic pressure (LVEDP), and transmitral pressure gradient (PG) was calculated. Those patients who have echo contrast on echocardiography were given 5000 IU heparin IV after septal puncture. Antibiotic prophylaxis was initiated in all patients thereafter. The procedure was performed under local anesthesia, if needed moderate sedation was given with midazolam. The procedure was ended when either at least one commissure was splitted, adequate increase in mitral valve area or increase in degree of MR or decrease in mean LA pressure to 1⁄2 of pre PTMC value or decrease in mitral valve gradient was observed. After 24-48 hours patient was discharged and before discharge transthorasic echo was done to measure all the parameters as pre PTMC along with any echo finding of pericardial effusion. Results: Total 124 patients were studied, 92(74.2%) were female and 32(25.8%) were male showing a female predominance. The mean age was 27.29±9.3. Most of the patients 58(46.8%) were in age group 21-30 years. 87(70.16%) patients were in atrial fibrillation and 37(29.83%) had sinus rhythm. The procedure was successful in 118(95.16%) patients. 2(1.6%) patients need urgent MVR due to severe MR and 1 (0.8%) died during procedure. Most of the patients 85(68.55%) were in NYHA class III. After PTMC, ASD was present in 13(10.5%) patients. After PTMC moderate MR was seen in 2(1.6%) and severe MR was observed in 4(2.173%) patients. Most of the patients 115(92.7%) before PTMC were in severe pulmonary hypertension and after PTMC most of the patients 91(73.4%) were in mild pulmonary hypertension. Pre PTMC mean MVA (cm2) was 0.684± 0.1226 and post PTMC it was 1.533± 0.281 cm2. Mean MVPG pre PTMC was 26.178±5.94 mmHg and post PTMC it was 7.62±5.007 mmHg with significant p value 0.0001. Mean LA pressure before procedure was 29.68±8.137 mmHg and post PTMC it was 12.28±6.99 and p value was 0.0001. 10 patients had special problems, 3 had previous H/O PTMC, 3 were pregnant lady, one has kyphoscoliosis, one had large IAS aneurysm, one had H/O CVA and one patient was suffering from renal cell carcinoma. Conclusions: The outcome of this study suggests that PTMC is a safe procedure in experienced hand with good success rate and optimal results even in patients with special problems like pregnancy, previous CVA and redo cases.

/pdf/percutaneous-transmitral-commissurotomy-ptmc-procedural-t18u7tk9nl.pdf

Percutaneous transmitral commissurotomy (ptmc); procedural success and immediate results, a tertiary care hospital experience from developing country

background: Rheumatic heart disease is one of the most common heart diseases in developing country; however rheumatic mitral stenosis in children is relatively rare. Percutaneous transluminal mitral commissurotomy is a well established therapeutic intervention for mitral stenosis in adults. The study is conducted to determine the efficacy and safety of PTMC in children with severe mitral stenosis. Methods: A single centre retrospective study is conducted over a 3 and half years period (from 16 th November, 2009 to 15 th May, 2013) in Shahid Gangalal National Heart Centre, Kathmandu, Nepal. All consecutive patients aged less than 15 years who underwent Percutaneous transluminal mitral commissurotomy for severe mitral stenosis were included. Mitral valve area, left atrial pressure and mitral regurgitation were compared pre and post procedure. Results: During the study period, 2237 patients underwent Percutaneous transluminal mitral commissurotomy. Among them 100 children less than 15 years of age were included. Successful results were obtained in 94 (94%) patients. Mitral valve area increased from 0.7±0.15 cm 2 to 1.5±0.32 cm 2 (p<0.001). A significant decrease in left atrial pressure was observed from 29±7.9 mmHg to 13.9±6.2 mmHg (p<0.001). There was no significant change in grade of post procedural mitral regurgitation. Conclusions: Percutaneous transluminal mitral

/pdf/percutaneous-transluminal-mitral-commissurotomy-in-nepalese-2a1p1kjbli.pdf

Percutaneous Transluminal Mitral Commissurotomy in Nepalese children with Rheumatic Mitral Stenosis

Background and Aim: Percutaneous balloon mitral valvotomy is well established as safe and effective procedure for patients with mitral stenosis due to Rheumatic Heart Disease. There are some retrospective studies on safety and efficacy of it in different subgroups of patients from our centre. Our study aims to assess the safety, efficacy and outcome of it in Shahid Gangalal National Heart Centre, Kathmandu, Nepal. Methods: A Single centre, prospective study was conducted from July 1st 2013 to June 31st 2014 in our centre. All the patients who underwent percutaneous balloon mitral valvotomy for moderate to severe mitral stenosis during the study period were included. Safety and efficacy of the procedure was analyzed. Results: There were 262 patients enrolled in the study among which 194 (74%) were females. Mean age of patients was 33.2±12.5 years. Seventy patients (26.7%) were in atrial fibrillation, six (2%) were pregnant, three (1%) had history of stroke, twelve (4.6%) underwent previous surgical or balloon commissurotomy. The mean left atrial pressure reduced from 26.8 ± 8.9 mmHg to 15.6 ± 7.2 mmHg (p < 0.05).The mean mitral valve area increased from 0.9 ± 0.17 cm2 to 1.6 ± 0.28 cm2 (p < 0.05). Forty nine patients (18.7%) developed moderate to severe mitral regurgitation. There was no mortality related to the procedure. The procedural success was achieved in 84% patients. Conclusion : Our study suggests that percutaneous balloon mitral valvotomy is a safe and effective procedure for symptomatic mitral stenosis patients. DOI: http://dx.doi.org/10.3126/njh.v12i1.12325 Nepalese Heart Journal Vol.12(1) 2015: 11-14

/pdf/immediate-outcome-of-percutaneous-balloon-mitral-valvotomy-4903lcqusa.pdf

Immediate Outcome of Percutaneous Balloon Mitral Valvotomy in Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal

Objective: The objective of our study was to assess the reduction in severe pulmonary hypertension after PTMC in patients of severe mitral stenosis. Methodology: One hundred twenty-four patients of severe mitral stenosis with severely elevated pulmonary pressures more than 50 mmHg between 15 to 60 years of age of either gender undergoing elective PTMC at Chaudry Pervaiz Elahi Institute of Cardiology, Multan were included in this study. Post PTMC pulmonary pressures were noted 24 hours after PTMC. Results: Mean age of the patients was 35.45 ± 10.38 years. Diabetes mellitus was found to be present in 39/124 (31.5%), hypertension in 40/124 (32.3%) while no comorbidities were found in 62/124 (50%). Mean baseline pulmonary artery systolic pressure was found to be 72.61 ± 8.11 mmHg while mean pulmonary artery systolic pressure after PTMC was found to be 45.09 ± 6.06 mmHg. The pulmonary artery systolic pressure fallen from baseline by 37.92 ± 4.19 mmHg after the commissurotomy. Transvenous mitral commissurotomy was found to be effective with a minimum 1/3rd reduction in 119/124 (96%) while it was ineffective in 5/124 (4%) of the patients. Conclusion: Therefore, we conclude that balloon valvotomy is a useful procedure which results in a significant reduction in mean pulmonary artery systolic pressure irrespective of age, gender or comorbidities.

/pdf/effectiveness-of-percutaneous-transvenous-mitral-3bd8lsqqeq.pdf

Effectiveness of percutaneous transvenous mitral commissurotomy (ptmc) in reducing pulmonary hypertension in patients with severe mitral stenosis

.. Objectives: To evaluate the immediate outcomes of PTMC in patients with severe mitral valve stenosis. Study Design: Cross-sectional study. Setting: Ninety (90) subjects who underwent PTMC in Cardiac Catheterization Department of CPE Institute of Cardiology. Period: June 2008 to June 2011. Methods: Patients with severe MS having mitral valve (MV) area <1.0 cm2 and having morphology suitable for PTMC in the absence of regurgitation and left atrial clot were included in this study. An increase in mitral valve area more than 50% of the baseline area without the development of moderate to severe MR was considered as the procedural success. Data were analyzed using SPSS V19. Pre and post procedural outcomes were measured using paired sample t-test. Results: There were a total number of ninety (90) patients in this study. Mean age of subjects was 28.08+9.61 years. There were more females 59 (65.5%) as compared to only 31 (34.5%) males. There was significant increase in mitral valve area, 1.83+0.36 cm2 post-PTMC versus 0.63+0.17 cm2 pre-PTMC (p-value <0.001). There was significant decrease in Peak pressure gradient (PPG) from 28.31+6.01 mmHg to 12.85+3.20 mmHg after PTMC (p-value <0.001). There were also significant reductions in mean pressure gradient and pulmonary artery systolic pressures after PTMC with p-value <0.001 and <0.001 respectively. PTMC was successful in 87 (97.7%) patients and it failed in only 3 (3.3%) patients. Conclusion: PTMC is an excellent treatment option regarding optimal outcomes and success rate in patients of severe mitral stenosis especially when performed by experienced interventionists.

/pdf/severe-mitral-stenosis-in-hospital-outcomes-of-percutaneous-1svdxjx4ej.pdf

Severe mitral stenosis; in-hospital outcomes of percutaneous transvenous mitral commissurotomy (ptmc) in patients

Background : Balloon valvuloplasty for stenosed mitral and pulmonary valves has been practiced with good results for the last two years in Ahmed Gasim Cardiac Centre, Khartoum Sudan. Objectives : The aim of this study is to audit percutaneous trans-mitral balloon commissurotomy [PTMC] in our current set up. Methods : One hundred and eight patients underwent percutaneous transvenous mitral commissurotomy (PTMC) from April- 2004 to December-2005 in Ahmed Gasim cardiac center. Results : 67% percent of the patients were females. Age range was from 13years to 65years and the mean age was 27years. 27% were under 21 years of age and 12% had special problems. The procedural success was achieved in 94.5% patients, in two patients we failed to dilate a tough septum, in other two the balloon got stuck to the septum and failed to cross the MV, while two patients had successful emergency MVR (due to inadvertent puncture of the RA and cardiac tamponade). There was no mortality related to the procedure, significant mitral regurgitation of > grade 2 didn't occur. No patient developed systemic embolization. Optimal results were achieved in 91.6% patients and in 92% of the patients with special problems. Hemodynamic data in the Cath. Lab showed left atrial mean (±SD) pressure dropped from 32 (±3.2) mmHg to 12 (±2.4) mmHg. LA-LV gradient dropped from an average of 25 to 5 mmHg. Echocardiographic assessment showed mean (±SD) mitral valve area increased from 0.86 (±0.19) cm 2 to 1.9 (±0.5) cm 2 (p Conclusion : We conclude that PTMC is a safe procedure with good success rate and optimal results even in patients with special problems like redo and previous CVA. Sudan Journal of Medical Science Vol. 1 (2) December 2006: 115-120

/pdf/percutaneous-transmitral-balloon-commissurotomy-ptmc-56m6afmf4a.pdf

Percutaneous Transmitral Balloon Commissurotomy [PTMC] Procedural success and immediate results at Ahmed Gasim Cardiac Center

Development of Ismail’s Guide Wheel on the Management of Epithelial Ovarian Cancer Including Fallopian Abstract We designed Ismail’s Guidewheel on the Management of Epithelial Ovarian Cancer Including Fallopian Tube and Primary Peritoneal Cancer to help guide physicians through a standardized approach to the primary and adjuvant therapy for patients diagnosed with those conditions along with surveillance and the management of recurrent disease. We amalgamated recommendations from international health organizations on a wheel, which can easily be used during a consultation with a patient to provide a simplified yet comprehensive approach to their management. We included recommendations by the following organizations: the National Comprehensive Cancer Network (NCCN), the American College of Obstetricians and Gynecologists, the American Society of Clinical Oncology (ASCO), the Society of Gynecologic Oncology (SGO), the British Gynecological Cancer Society (BGCS), the National Institute of Care and Excellence (NICE), the Royal College of Obstetricians and Gynaecologists (RCOG), the Scottish Intercollegiate Guidelines Network (SIGN), the European Society of Gynaecological Oncology (ESGO), the European Society for Medical Oncology (ESMO), the Korean Society of Gynecologic Oncology (KSGO), the Spanish Society of Medical Oncology (SEOM), the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the International Federation of Gynecology and Obstetrics (FIGO). This wheel is meant to be a quick and accessible resource for physicians but is not intended to replace alogorithms set by the aforementioned organizations.

/pdf/development-of-ismails-guide-wheel-on-the-management-of-27kct5i1.pdf

Development of Ismail’s Guide Wheel on the Management of Epithelial Ovarian Cancer Including Fallopian Tube and Primary Peritoneal Cancer

Evidence-based medicine (EBM) is a rapidly expanding subject. The aim of this editorial is to give an overview and address some of the practical issues relevant to the developing world. EBM may be defined as the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. Sudan Journal of Medical Science Vol. 1 (2) December 2006: 93-96

Evidence based medicine, an innovative approach to an old practice

We developed Ismail’s Guide wheel on the Management of Less Common Ovarian Cancers as an extension to Ismail’s Guide wheel on the Management of Epithelial Ovarian Cancer Including Fallopian Tube and Primary Peritoneal Cancer. The former mainly discusses the adjuvant therapy for patients with less common epithelial ovarian cancer such as clear-cell carcinoma and mucinous carcinoma along with non-epithelial OC such as malignant sex cord-stromal tumors, malignant germ cell tumors and carcinosarcomas while the latter also discusses the primary therapy for those types of tumors. This guide wheel comprises of an amalgamation of the recommendations by international health organizations including the National Comprehensive Cancer Network (NCCN), the Society of Gynecologic Oncology (SGO), the British Gynecological Cancer Society (BGCS), the National Institute of Care and Excellence (NICE), the Royal College of Obstetricians and Gynecologists (RCOG), the European Society of Gynecological Oncology (ESGO), the European Society for Medical Oncology (ESMO), the Korean Society of Gynecologic Oncology (KSGO), the Spanish Society of Medical Oncology (SEOM), the Society of Obstetricians and Gynecologists of Canada (SOGC) and the International Federation of Gynecology and Obstetrics (FIGO). Ismail’s Guide wheel on the Management of Less Common Ovarian Cancers serves as a quick, feasible reference for physicians when counseling patients diagnosed with those less common ovarian cancers regarding the expected course of treatment bearing in mind the significance of individualizing treatment to each patient’s unique case.

/pdf/development-of-ismails-guide-wheel-on-the-management-of-less-clyct37i.pdf

Development of Ismail’s Guide wheel on the Management of Less Common Ovarian Cancers

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Alkhalifa

Author Tools

Chat about Author

Papers

Percutaneous Transmitral Balloon Commissurotomy [PTMC] Procedural success and immediate results at Ahmed Gasim Cardiac Center

Development of Ismail’s Guide Wheel on the Management of Epithelial Ovarian Cancer Including Fallopian Tube and Primary Peritoneal Cancer

Evidence based medicine, an innovative approach to an old practice

Development of Ismail’s Guide wheel on the Management of Less Common Ovarian Cancers