Immediate Reduction in Pulmonary Artery Systolic Pressure Following Percutaneous Transmitral Commissurotomy in Patients with Severe Rheumatic Mitral Stenosis: A Descriptive Case Series

Abstract

Objectives: To determine the frequency and magnitude of reduction in pulmonary artery systolic pressure (PASP) within 24 hours after Percutaneous Transmitral Commissurotomy (PTMC) in patients with severe rheumatic mitral stenosis. Methodology: This descriptive case series included a total of 60 patients aged 18–60 years with severe rheumatic mitral stenosis (mitral valve area ≤1.5 cm²) and pulmonary artery systolic pressure >50 mmHg were enrolled using a non-probability consecutive sampling technique. Pulmonary artery systolic pressure was measured using Doppler echocardiography before PTMC and repeated 24 hours after the procedure. Reduction in PASP was defined as a decrease of ≥33% from baseline values. Results: A total of 60 patients were included in the study. The mean age was 45.17 ± 11.37 years, and 40 (66.7%) participants were male. The baseline mean PASP was 73.57 ± 3.43 mmHg, which significantly decreased to 42.23 ± 16.94 mmHg after PTMC (p <0.001). Reduction in PASP of ≥33% was observed in 25 (41.7%) patients, while 35 (58.3%) patients did not achieve the predefined reduction threshold. Stratification analysis demonstrated no statistically significant association between reduction in PASP and age or gender (p >0.05). Conclusion: PTMC was associated with a significant immediate reduction in pulmonary artery systolic pressure among patients with severe rheumatic mitral stenosis; however, clinically meaningful reduction was achieved in only a subset of patients. Larger multicenter studies with long-term follow-up are recommended to further evaluate the prognostic significance of early hemodynamic improvement after PTMC.