Md. Toufiqur Rahman MBBS, FCPS, MD, FACC, FESC, FAPSIC, FAPSC, FRCP,FAHA1

Syed Azizul Haque MBBS, FCPS, MD, FACC, FRCP2

AAS Majumder MBBS, D.CARD, MD, FACC, FRCP,FESC, FSCAI3

Afzalur Rahman MBBS, MD, PhD, FACC, FRCP4

1.Associate Professor, Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka.2.Professor, Department of Cardiology, Dinajpur Medical College & Hospital.3.Director and Professor, Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka.4.Professor, Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka.

Correspondence to: Dr. Md. Toufiqur Rahman, MBBS, FCPS, MD, FACC, FESC, FAPSIC, FAPSC, FRCP, FAHA Associate Professor, Cardiology, Room No.225, North Block, National institute of Cardiovascular Diseases (NICVD), Dhaka., E-mail: drtoufiq19711@yahoo.com; drtoufiq1971@gmail.com

Rheumatic fever and rheumatic heart disease continue to be the

major health problem in all developing countries including

Bangladesh. Percutaneous Transvenous mitral Commissurotomy

(PTMC) is an established non-surgical modality for the treatment

of severe rheumatic mitral valve stenosis.

To compare immediate and in-hospital outcome of PTMC with

or without heparin administration.

The study group included 552 consecutive patients who underwent PTMC at the National Institute of cardiovascular Diseases (NICVD), Dhaka and Al –Helal Heart Institute, Mirpur, Euro-Bangla Heart Hospital, Lalmatia, Dhaka between May 2003 and December 2012. Safety, efficacy and in-hospital results of percutaneous transvenous mitral commissurotomy were analyzed in 264 patients with heparin (group 1) and compared with 288 those of without heparin(group 2). Heparin was allocated randomly.

Parameters Group-I Group-II P Value

(with heparin) ( without heparin) N = 264 N=288

Age ( years ) 43 ± 11 44 ± 12 NSSexMale 54 ( 20.2 % ) 48 (16.1 %) NSFemale 210 (80.3 %) 240 ( 84.4 % ) NS

Parameters Group-I Group-II P Value

(with heparin) ( without heparin) N = 264 N=288

RHD status MS 144 (55.26%) 174 (60 .13%) NSMS with MR < 120 ( 44. 74 % ) 114 ( 39.87 % ) NSGrade –II

NYHA Status Class 1-II 146 (55.80%) 57 (54. 20%) NSClass-III-IV 118 (44. 20%) 131 (45.80%) NS

Wilkins Echo score <8 159 (60.2%) 169 (58.8%) NS >8 105 (39.8 %) 119(41.2%) NSFluroscopic Calcium > 2+ 66 (25.0%) 71 ( 24. 8%) NSPrior Commissurotomy 57 (22.2%) 67 (23.0%) NSMitral Regurgiitation <2 108 (41.2%) 116(40.4%) NS

Parameters Group-I Group-II P Value

(with heparin) (without heparin)N = 264 N=288

MVA ( cm2 ) 0.85 ± 0.09 0.85 ± 0.25 NSTransmitral gradient-MPG mmHg ) 26 ± 03 22± 06 NSLA size ( mm ) 51 ± 05 48± 10 NSLA Pressure (mmHg) 52 ±08 47±09 NSAortic Pressure mmHg ) 87±11 94±11 NS

Parameters Group-I Group-II P Value(with heparin) (without heparin)

N = 264 N=288

MVA ( cm2 ) 1.76 ± 0.07 1.76 ± 0.19 NS Transmitral gradient-MPG (mmHg ) 08 ± 02 07 ± 04 NSLA size ( mm ) 47 ± 05 45 ± 05 NSLA Pressure (mm Hg) 18 ± 7 12 ± 5 Aortic Pressure (mmHg) 96 ± 03 98 ± 08 NS

Characteristics Group-I N = 264 Group-II N=288 P Value

Procedural success 240 ( 90.9 % ) 264 ( 91.6 % ) NSProcedural death 0 0 NSIn hospital death 02 ( 0.75 % ) 01 ( 0.3% ) NSMR grade—Post PTMC 2 + 10 ( 03.8%) 08 ( 02.8 % ) NS 3 + 10 ( 03.8% ) 04 ( 01.4 % ) NSLeft to right shunt (ASD ) 20 ( 07.5 % ) 16 ( 05.5 % ) NS AV block 0 0 NS Local vascular 30 ( 11.4 % ) 24 ( 08.4 % ) NS complications like pain,hemorrhage, hematomaThromboembolism 03 ( 0.9 % ) 2( 0.8 % ) NSPericardial 03 ( 0.9 % ) 03 ( 0.10 % ) NS temponade (Haemopericardium)

Heparin administration during PTMC is not associated with any

additional protective effect against embolic events during

procedure and in-hospital stay.