A weighted risk score to predict post-PTMC mitral regurgitation
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Interventional Structural
ORAL ABSTRACTS
PERCUTANEOUS TRANSCATHETER CLOSURE OF RUPTURED SINUS OF
VALSALVA ANEURYSM: IMMEDIATE RESULTS AND LONG-TERM
FOLLOW-UP
Prayaag Kini, P.K. Dash, Reeta Varyani. Sri Sathya Sai Institiute of Higher
Medical Sciences, Whitefield, Bangalore, India
There is paucity of data on closure and long-term follow-up of percuta-
neous treatment of RSOV. In this article, we present our experience of the
same with both immediate results and long term follow-up upto 6 years,
probably one of the longest follow- ups series in India.
Type of study: Retrospective data collection with prospective analysis.
Materials and method: Data regarding percutaneous RSOV closure be-
tween Jan 1 2009 and July 2018 was retrieved from in- hospital database.
Patient demographics, clinical data and echocardiographic findings were
analysed.
Results: RSOV device closure was attempted in 65 (46 M, 15 F) patients
and successfully completed in 61 of them,the age-range being 18 to 55
years. (mean 28.7?±?6.5 yr, median 32 yr). Echocardiography revealed
RSOV from right coronary sinus (RCS) to right atrium (RA) in 25 patients
(41 %), RCS to right ventricular outflow in 17 (27.8%), RCS to RV in 11, and
noncoronary sinus ruptured into RA in 12 patients (~18% each). Associ-
ated defects were BAV in three patients, mild preexisting AR in six,
valvular pulmonic stenosis which was concomitantly dilated in three
patients, and healed IE, and ASD and coronary AV fistula to RA in one
patient each. 41 patients were in NYHA class II, 21 in Class III and three,in
class IV. Defect size ranged from 6 -13mm (mean 7.4?±?1.3 mm). RSOV
were closed with device selection 2 to 4?mm higher than the defect size
in fluoroscopy and if needed (n¼ 5) with TEE guidance. Technical success
was 94.5%. We used Cocoon and Amplatzer ductal occluders in 39 pa-
tients, muscular VSD muscular occluders in 17, with ASD septal occluder
in three and Amplatzer vascular plug in 2 patients respectively.Largest
size of duct occluder was 16/14 ADO 1, smallest was 8/6 ADO 1 and mean
device size was 12.0?±?1.6 mm/10.0?±?1.6 mm. Mean fluoro time was
less than 6 mins with better experience. Six patients (85.7%) who had
mild residual shunt. Patients referred for surgery were three- one due to
embolization to RV that could not be retrieved percutaneously (device
being stuck in TV apparatus) and two patients for hemolysis. One patient
had hemolysis till 36 hours post implantation which then settled down
spontaneously. Three patients developed junctional rhythm post implant
that reverted to sinus rhythm by 12-24 hours. No deaths/ infection
occurred in the study and only three patients had mild groin hematoma.
Follow- up: During a minimum of 14 months to maximu m 76 months
follow-up of percutaneously closed RSOV patients, 57 patients were
asymptomatic with four being in NYHA class I. There was no residual
shunt, progression of AR or new AR, infective endocarditis, rhythm dis-
turbances (as per history) or device embolization. LV size regressed to
normal in 19/ 24 patients who initially had chamber enlargement (LV/RV)
and decreased from pre- implant in the rest.
Conclusion: Percutaneous closure of RSOV appears to be a safe alternative
to surgical closure with favourable LV remodelling on follow up.
A WEIGHTED RISK SCORE TO PREDICT POST-PTMC MITRAL
REGURGITATION USING MACHINE LEARNING TECHNIQUES -
OBSERVATIONS FROM A LARGE-VOLUME TERTIARY CARE CENTRE IN
SOUTH INDIA
Prayaag Kini, P.K. Dash, Reeta Varyani. Sri Sathya Sai Institute of Higher
Medical Sciences, Bangalore, India
Despite years of experience in PTMC, development of MR remains a
prevalent complication.Wilkins score was not meant to predict the
development of post PTMC MR but it has not been studied hitherto
whether it can be modified to study the latter.
Aim: To determine predictors of the development of MR following PTMC
and building upon the most commonly used Wilkins score with para-
metric weightage with additional parameters.
Materials and Methods: We studied 3338 patients with rheumatic MS
undergoing PTMC. Inclusion and exclusion criteria for the study were
standard accepted criteria for PTMC .Patients were divided into Group A
(patients without MR/mild MR) and Group B (significant grades of post-
PTMC MR). Both groups were comparable with regards to their de-
mographics, clinical parameters other than MV Wilkins’ scoring, and
number of indiati ons.We studied mitral valve morphology, and included
other parameters like severity of IAS bulge,irregular thickening of leaflet,
and presence of calcified nodules. PTMC was done using Accura balloon.
Doppler classified MR as leaflet tear OR commissural MR, and chordal
rupture (partial or complete). Multiple stepwise logistic regression
analysis was performed to determine the predictor(s) of developing
MR. ‘p’ values were considered significant if 0.05) were all significantly
higher and were predicted development of severe post-PTMC MR.
There was also an association with previous PTMC/CMV done
(p¼0.04).Weighted Wilkins score: Next we divided the 155 patients in
group B patients into a deterministic cohort (n¼ 80) and a prospective
cohort (n¼ 75).Using Machine-learning,we gave weightage factors to the
parameters in Wilkins score.The composite score was evaluated on
prospective cohort for its strength of association for developing MR and
its goodness of fit. Giving weightage of 5 for nodular calcium, 3 for
irregular thick-thin areas, 2 for IAS septal bulge,2 for past CMV/OMV, 2
for AF, and 1 each for valve mobility,valve thickness and subvalve dis-
ease, we achieved high positive predictive value of 88% for predicting
the development of MR (model c-statistic ¼ 0.88).Composite WWS
of 12/18 was an independent predictor of a 3.2-fold increase in devel-
oping MR
LONG TERM FOLLOW-UP OF PATIENTS UNDERGOING STENTING VS.
ENDARTERECTOMY FOR CAROTID ARTERY STENOSIS e AN INDIAN
PERSPECTIVE
Kartik Pandurang Jadhav. Amrita Institute of Medical Sciences, Kochi, India
Background: Although Carotid artery stenting and carotid endarterec-
tomy are both viable options for treating carotid artery stenosis, Indian
data on the outcomes of these procedures is limited. Methods This retro-
spective study analyzed the data of all the patients who underwent either
Contents lists available at ScienceDirect
Indian Heart Journal
journal homepage: www.elsevier.com/locate/ihj
Indian Heart Journal 70 (2018) S77eS81
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