Mid and Long Term Echocardiographic and Clinical Follow up of Treated Rheumatic Mitral Stenosis Patients

Introduction- Rheumatic mitral stenosis (MS) is a common valvopathy in developing countries that requires invasive or minimally invasive treatment. There is scarcity of data regarding the long term follow up of treated MS patients. Aim- The aim of this study was to compare the long-term outcomes of biologic and mechanical prosthesis and percutaneous transvenous mitral commissurotomy (PTMC) in treated MS patients. Materials and Methods- This historical cohort study was conducted on treated MS patients who underwent treatment in a tertiary hospital in Mashhad, Iran. Treated MS patients were identified and asked to refer to the center for follow up. Demographic characteristics and type of treatment intervention were obtained from patient records. The follow up assessment included history of PTMC, readmission and echocardiography to assess trans mitral gradient (MG), size and function of right ventricle (RV) and the presence and severity of other valvopathies. Results- A total of 135 patients (21.5% males and 78.5% females) with the mean age of 43.68 ± 11.17 years old participated in the study. The most common intervention method was mechanical valve (61.5%) followed by PTMC (24.4%) and biologic valve (14.1%). Median follow up duration was 4 years. Majority of subjects (52.6%) remained asymptomatic and the functional class was reduced significantly compared to baseline. MG was significantly higher in PTMC and biological valve group compared to mechanical valve p<0.001). Mitral regurgitation (MR) was more prevalent in PTMC group (p<0.001) while abnormal RV size and function the least common in PTMC group (p=0.014 and p=0.002 respectively). Conclusions- All intervention groups resulted in improved functional class of MS patients but high prevalence of MR and lower prevalence of abnormal RV size and function were observed in PTMS group compared to surgical groups.