CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 1, January – April 2024 AFRICA 19 tricuspid regurgitation velocity jet was 56.37 ± 21.60 mmHg. About a quarter were in NYHA functional class III–IV and nine (16.7%) had reduced left ventricular ejection fraction (LVEF). The mean mitral valve area was 0.89 ± 0.19 cm2 and the mean transmitral pressure gradient was 15.66 ± 4.25 mmHg. The mean tricuspid annular plane systolic excursion (TAPSE) was 16 ± 2.93 (Table 1). TTE was done on all patients while TEE was done on 29 patients (Table 2). Nine patients were in AF, of whom three patients had LA thrombus. Only one of these patients had detectable left atrial thrombus on TTE while the other two patients required TEE for detection. Fig. 4 shows the echocardiography of a patient with a left atrial thrombus in AF. As depicted in Table 2, 34 patients were in normal sinus rhythm, of whom two patients had left atrial thrombus on TEE but not on TTE. These two patients with normal sinus rhythm had left atrial volume index (LAVI) of 88 and 90 ml/ m2, respectively. Nine patients in normal sinus rhythm had left atrial spontaneous echo contrast (LASEC) of moderate to severe Table 1. Sociodemographic and clinical characteristics of patients evaluated for percutaneous mitral balloon valvuloplasty at JKCI from August 2019 to May 2022 (n = 43). Variable Mean (± SD) or median (range)/frequency (%) Median age (years) 31 (11–68) Female gender 32 (74.4) Mean duration of symptoms (months) 43.26 ± 30.03 Proportion residing outside Dar es Salaam 38 (88.4) Proportion not married 25 (58.1) Proportion without health insurance 25 (58.1) Proportion with monthly income < 42$ 24 (55.8) Proportion with primary education 21 (48.8) Proportion with stroke 4 (9.3) Proportion with hypertension 7 (16.3) Proportion with atrial fibrillation 9 (20.9) Proportion with NYHA class III–IV 12 (27.9) Proportion on anticoagulants 11 (25.6) Mean LVEF (%) 60.67 ± 8.73 Mean Wilkins score 8.63 ± 0.93 Mean RVSP (mmHg) 56.37 ± 21.60 Mean LA diameter (mm) 51.39 16 ± 8.98 Mean mitral valve area (cm2) 0.89 ± 0.19 Mean transmitral pressure gradient (mmHg) 15.66 ± 4.25 Mean TAPSE 16 ± 2.93 NYHA, New York Heart Association; LVEF, left ventricular ejection fraction; RVSP, right ventricular systolic pressure; TAPSE, tricuspid annular plane systolic excursion; LA, left atrium. Fig. 3. A map of Tanzania showing the residence of 290 patients enrolled in the TAMS study. Table 2. Characteristics of the patients evaluated for PBMV (n = 43) Case no Age Gender Wilkins score ECG rhythm TTE LA thrombus TEE LA thrombus Spontaneous echo contrast Disposal Status 1 16 F 8 Sinus No No No PBMV Done 2 62 F 8 AF Yes – Yes PBMV Re-scheduled† 3 42 F 8 AF No No No MVR* Done 4 28 F 8 Sinus No No No PBMV Failed 5 30 F 8 Sinus No – No PBMV On waiting list 6 18 F 8 Sinus No – No PBMV On waiting list 7 20 F 8 Sinus No – No PBMV On waiting list 8 35 F 8 Sinus No No No PBMV Done 9 42 F 8 AF No Yes Yes PBMV Re-scheduled† 10 43 F 8 Sinus& No No Yes PBMV On waiting list 11 19 M 8 Sinus No No No MVR# Scheduled 12 25 F 8 Sinus No - No PBMV On waiting list 13 35 F 8 Sinus No No No PBMV Done 14 49 F 8 AF No – No PBMV On waiting list 15 11 F 8 Sinus No – No PBMV Died before op 16 19 M 8 Sinus No – No PBMV On waiting list 17 20 F 8 AF No – No PBMV On waiting list 18 62 M 8 AF No – No MVR* Scheduled 19 19 M 8 Sinus No No No MVR* Done 20 13 F 8 Sinus& No No Yes PBMV Died before op 21 17 F 8 Sinus& No No Yes PBMV Failed 22 33 F 8 Sinus No Yes Yes MVR* Done 23 39 F 8 Sinus No Yes Yes MVR* Scheduled 24 30 F 8 Sinus No - No PBMV On waiting list 25 31 F 9 Sinus No No No PBMV Done 26 16 M 9 Sinus No – No PBMV On waiting list 27 24 F 9 Sinus No No No PBMV Done 28 47 F 9 AF No No Yes PBMV Done 29 68 F 9 AF No No Yes MVR# Done 30 45 F 9 Sinus No No Yes PBMV Done 31 48 F 9 Sinus& No No Yes PBMV Died before 32 42 F 9 Sinus& No No Yes PBMV Done 33 49 F 9 AF No Yes Yes MVR* Scheduled 34 45 F 9 Sinus No No No MVR* Done 35 60 M 9 Sinus No – No MVR* Done 36 61 F 9 Sinus No No No MVR* Done 37 15 F 10 Sinus No – No PBMV On waiting list 38 28 F 10 Sinus& No No Yes MVR* Done 39 16 F 10 Sinus No No No MVR* Done 40 20 M 10 Sinus& No No Yes PBMV Done 41 17 M 11 Sinus& No No Yes PBMV Done 42 35 F 11 Sinus& No No Yes MVR* Done 43 20 M 12 Sinus No No No MVR* Scheduled ECG, electrocardiography; TTE, transthoracic echocardiography; TEE, transoesophageal echocardiography; LA, left atrial; AF, atrial fibrillation; PBMV, percutaneous ballooon mitral valvuloplasty; MVR, mitral valve regurgitation. *Unfavourable anatomy, #unfavourable clinically, &smoke in normal sinus rhythm, †LA thrombus alone.
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