LEFT VENTRICULAR SYSTOLIC DYSFUNCTION AS A SURROGATE FOR RHEUMATIC MYOCARDITIS IN PATIENTS WITH ISOLATED RHEUMATIC MITRAL STENOSIS

Abstract

Objective: To know the frequency of LV dysfunction as a surrogate for rheumatic myocarditis in patients with isolated mitral stenosis (MS) after successful percutaneous transluminal mitral commissurotomy (PTMC). Methodology: This Descriptive study was conducted from January to December 2011 in Cardiology Department of Lady Reading Hospital Peshawar. Patients with severe isolated MS undergoing echocardiography before and after PTMC were included. Results: A total of 141 patients with severe isolated MS have undergone successful PTMC were studied. Females were 97(68.8%). Mean age was 26.74±7.24years.TTE was performed before PTMC showing mean MVA 2 0.8cm±0.2cm . Mean MV gradient was 22.3± 16.7 mm of Hg. Mean LA diameter was 4.8± 2.4 cm. AF was found in 63 (44.36%). Mean RVSP was 55.67±23.41mm of Hg. LV systolic dysfunction i.e. EF< 50 % was found in 24 (17.02%) of patients. The LV systolic function was mildly impaired in 13 (9.2%), moderately impaired in 7(4.9%) and severely impaired in 4 (3%) of the study group. TTE 24 hours after PTMC shows mean left atrial diameter of 4.3±2.3cm, 2 mean MV area of 1.74±0.41cm , mean MV gradient of 5.21±4.9 mm of Hg, mean RVSP 29±16.34 mm of Hg, while left ventricular systolic dysfunction was present in 14.3% of patient with mild degree impairment in 10 (7.1%), moderately impaired in 6 (4.2%) and severely impaired in 4 (3%) of the study group. Conclusion: The LV systolic dysfunction which is used as a surrogate of rheumatic myocarditis occurs in about 14% of patients with isolated severe MS after successful PTMC.