CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 1, January – April 2024 20 AFRICA intensity (Fig. 5). The mean left atrial size for the occurrence of spontaneous echo contrast was 55.34 ± 11.24 mm. All patients with left atrial thrombus had associated LASEC. Acareful evaluation revealed that 15patients hadunfavourable anatomical characteristics characterised by: bi-commissural calcification (four patients), ≥ grade 2/4 mitral regurgitation (six patients), high scores and left atrial thrombus (three patients), and left atrial thrombus (two patients). Two patients had unfavourable clinical characteristics (severe pulmonary hypertension). Among these, 10 underwent mitral valve replacement (MVR), five were on schedule for MVR, and two (with left atrial thrombus) were re-scheduled for PBMV. Three patients died before the planned PBMV, presumably due to progressive heart failure. Eleven patients were on a waiting list for PBMV (Table 2). Table 3 shows the individual outcomes of patients who underwent PBMV. The procedure was done in 12 patients, of whom 10 (83.3%) were successful. There were no immediate post-procedural complications. The two patients in whom the procedure failed had a score of 8 each. Of the two failures, one was a problem with septal puncture and the other one was due to difficulties crossing the mitral valve orifice. Table 4 shows the MVA improvement and the haemodynamic changes produced by PBMV. The mean pre-PBMV was 16.03 ± 5.52 mmHg and the mean post-PBMV was 3.08 ± 0.44 mmHg (p < 0.001). PBMV resulted in a significant decrease in mitral gradient, left atrial and pulmonary arterial pressures and an increase in the MVA. There was a significant symptomatic improvement among all patients, attaining NYHA functional class I. With regard to the Wilkins score, improvements in MVA by planimetry in the two groups [1.6 (0.88) vs 1.63 (1.88), p = 1.00] and in haemodynamics, such as mitral gradient [8.5 (2.6) vs 14 (16.6), p = 0.117], left atrial pressure [2 (2) vs 4 (8), p = 0.117] and pulmonary artery pressure [5 (6) vs 2 (20), p = 0.517] were similar, as shown in Table 5. In the twomission visits, four local interventional cardiologists were supervised in performing PBMV. Fig. 6A shows the local team performing PBMV at JKCI catheterisation laboratory in May 2022. Fig. 6B shows the balloon inflated across the mitral valve. Fig. 4. Echocardiographic and electrocardiographic images taken from a patient with left atrial thrombus (A) in atrial fibrillation (B). A B Fig. 5. Echocardiographic and electrocardiographic images taken from a patient with left atrial severe spontaneous echo contrast ‘smoke’ (A) in normal sinus rhythm (B). A B
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