The Effect of Guidance of Transesophageal Echocardiography During Percutaneous Balloon Mitral Valvuloplasty on Procedural Success and Complications

Year 2018, Volume: 40 Issue: 3, 1 - 7, 01.09.2018

Muhammet Dural , Kamal Isgandarov , Gurbet Özge Mert Necmi Ata , Kadir Uğur Mert

https://doi.org/10.20515/otd.398350

Abstract

Patients with mitral stenosis (MS) can be treated with percutaneous
methods. In this patient population, MS and symptoms can be relieved by
percutaneous mitral balloon valvuloplasty (PMBV).  In our study we aimed to investigate the
effect of guidance of transesophageal echocardiography (TEE) during PMBV on
procedural success and complications in patients with MS. Fourty-five patients
who were planning to undergo PMBV because of severe MS were included to the
study. Procedure of PBMV performed in 23 patients with TEE guidance (TEE(+))
and in 22 patients without TEE guidance (TEE(-)). Transseptal puncture (TSP)
duration, transseptal transition success and transmitral transition success
evaluated for each group. All patients treated with PMBV were evaluated with
transthorasic echocardiography after 24. h and 12 weeks. The mean age in the TEE(+)
group of the study was 47,9±11,4 and 
48,5±15 (p=0,88) in TEE(-) group. The mean height was 163,1±7,5 cm in
TEE(-) group and 161,7±5,4 cm (p=0,47) in TEE(+) group. It was demonstrated
that Wilkins score was 8.5 (7.0-10.0) in the TEE (-) group and 9.0 (7.0-11.0)
in TEE (+) group (p = 0.111). TSP duration in the TEE (-) group and TEE (+)
group were 25,24 ± 5,1 min. and 21.86 ± 3.8 min (p = 0.02), respectively. In
the TEE (-) group, transmitral transition success was 100%, while in the TEE
(+) group it was 85.8%. In TEE (+) group, transmitral transition was more
unsuccessful but there was no statistically significant difference (p = 0.072).
Complications were similar in both groups. It was demonstrated that TEE
guidance during PMBV shortened the TSP duration despite there was no effect on
complications due to TSP, TSP success, transmitral transition success,
operation success, and operation complications. In PMBV procedure, TEE guidance
can be added to the conventional methods to shorten the procedure time and
minimize radiation exposure.

Keywords

Severe mitral stenosis, percutaneous balloon mitral valvulplasty, transseptal puncture, echocardiography

Perkütan Balon Mitral Valvuloplasti Sırasında Transözofajiyal Ekokardiyografi Kılavuzluğunun İşlem Başarısı ve Komplikasyonlar Üzerine Etkisi

Abstract

Semptomatik mitral
darlığı (MD) hastaları perkütan yolla tedavi edilebilmektedir. Bu hastalarda
perkütan mitral balon valvulaplasti (PMBV) ile MD ve semptomları
giderilebilmektedir. Bu çalışmamızda ciddi MD hastalarında PMBV işlemi
sırasında transözofajiyal ekokardiyografi (TEE) kılavuzluğunun işlem başarısı
ve komplikasyonlar üzerine etkisini araştırmak istedik. Çalışmaya ciddi MD ile
başvuran ve PMBV yapılması planlanan 45 hasta alındı. PMBV işlemi 23 hastaya
TEE kılavuzluğunda (TEE(+)), 22 hastaya ise TEE kılavuzluğu olmadan (TEE(-))
gerçekleştirildi. Çalışmada her iki grubun transseptal ponksiyon (TSP) süresi,
septum geçiş başarısı, kapak geçiş başarısı değerlendirildi. PMBV ile tedavi
edilen tüm hastalara 24. saat ve 12. haftada transtorasik ekokardiyografi ile
değerlendirildi. Çalışmaya alınan hastaların TEE(+) grubunda yaş ortalaması
47,9±11,4, TEE(-) grubunda ise 48,5±15 (p=0,88) idi. TEE(-) grubundaki
olguların ortalama boyu 163,1±7,5 cm, TEE(+) grubunda ise 161,7±5,4 cm (p=0,47)
olarak gözlendi. TEE(-) grubunda Wilkins skoru 8,5(7,0-10,0), TEE(+) grubunda
ise 9,0(7,0-11,0) (p=0,111) olarak gözlendi. TSP süresi TEE(-) grubunda ve
TEE(+) grubunda sırasıyla 25,24±5,1 dk. ve 21,86±3,8 dk (p=0,02) olarak tespit
edildi. TEE(-) grubunda kapak geçiş başarısı %100 iken, TEE(+) grubunda %85,8
olarak bulundu. TEE(+) grubunda mitral kapak geçişi daha başarısızdı ancak
istatistiksel anlamlı fark yoktu (p=0,072). Komplikasyonlar her iki grupta
benzerdi. PBMV esnasında kullanılan TEE’nin TSP’den doğan komplikasyonlar, TSP
başarısı, kapak geçiş başarısı, işlem başarısı, işlem komplikasyonları üzerine
ise herhangi bir etkisinin olmamasına rağmen TSP süresini kısalttığı
gösterildi. Hastalarda işlem süresini kısaltmak, radyasyon maruziyetini en aza
indirmek için PBMV işlemi sırasında TEE kılavuzluğu konvansiyonel yönteme
eklenebilir.

Keywords

Ciddi mitral darlığı, perkütan mitral balon valvuloplasti, transeptal ponksiyon

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