CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 1, January – April 2024 AFRICA 21 Discussion This single-centre, prospective study reports the first investigation of patients’ eligibility for PBMV and the immediate post-PBMV outcomes in Tanzania. The study further defines the role of the heart team and training/skills transfer in PBMV interventions. Lastly, we highlight the presentation of female gender in RHD. The main findings are: (1) TEE is mandatory in pre-PBMV screening to rule out left atrial thrombus as TTE does not always detect it, and for procedural guidance; (2) the ESC and AHA/ ACC guidelines14,15 need reconsideration for a good outcome of PBMV (cut-off Wilkins score ≤ 8). In our cohort, patients with Wilkins score of up to 11 underwent successful procedures; (3) PBMV had good short-term outcomes in the selected patients, which underscores the importance of appropriate patient selection in a multidisciplinary valvular heart team; and (4) in Tanzania, MS has a female predominance with presentation early in life. These findings are encouraging and lower the bar for performing PBMV in a large group of RHD-MS patients, given its short procedural time and short recovery period allowing the patient to return to family or work more promptly if needed. Our findings are an example of well-planned development, which if sustained, can make significant differences in the diagnosis, Table 3. Outcome of patients who underwent PBMV at JKCI from August 2019 to May 2022 (n = 12). Case no Wilkins score LA size (mm) Pre-PBMV transmitral gradient (mmHg) Post-PBMV transmitral gradient (mmHg) PrePBMV MR PostPBMV MR Compli- cations 1 8 44 11 3 Trace Mild None 4 8 46 14 – Mild – Failed 8 8 46 14 3.5 Trace Mild None 13 8 44 12 3 Trace Mild None 21 8 58 16 - Trace – Failed 25 9 60 21.2 3.5 Mild Mild None 27 9 46 10.9 3 Trace Mild None 28 9 50 10 2 Mild Mild None 30 9 47 17 3 Mild Mild None 32 9 45 18.2 3 Mild Mild None 40 10 42 12 3 Mild Mild None 41 11 58 28 3.4 Mild Mild None PBMV, percutaneous ballooon mitral valvuloplasty; LA, left atrial; MR, mitral regurgitation. – Not done. Table 4. Comparison of pre- and post-PBMV parameters of patients who underwent successful PBMV at JKCI from August 2019 to May 2022 (n = 10). Parameter Pre-PBMV Post-PBMV p-value Mean mitral valve area (cm2) 0.87 ± 0.16 2.25 ± 0.46 < 0.001 Mean mitral valve pressure gradient (mmHg) 16.03 ± 5.52 3.08 ± 0.44 < 0.001 Mean left atrial pressure (mmHg) 22.66 ± 3.89 8.00 ± 2.31 < 0.001 Mean pulmonary arterial pressure (mmHg) 38.40 ± 13.59 33.50 ± 11.29 < 0.001 PBMV, percutaneous ballooon mitral valvuloplasty. Table 5. Pre- and post-PBMV median (range) differences in improvement between groups Variable Wilkins score p-value ≤ 8 (n =3) 9–11 (n = 7) MVA improvement (cm2) 1.60 (0.88) 1.63 (1.18) 1.000 MV gradients improvement (mmHg) –8.50 (2.60) –14.00 (16.60) 0.117 LAP improvement (mmHg) –2.00 (2.00) –4.00 (8.00) 0.117 PAP improvement (mmHg) –5.00 (6.00) –2.00 (20.00) 0.517 MVA, mitral valve area; MV, mitral valve; LAP, left atrial pressure; PAP, pulmonary artery pressure; PBMV, percutaneous balloon mitral valvuloplasty. Fig. 6. A photograph showing the local team performing PBMV (A) and the balloon inflated across a stenosed rheumatic mitral valve (B). A B
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