Safe MR jets in PTMC

Significant MR is a contraindication for PTMC. However,  If MR jet is central , and mild (some times little more than mild as well ) PTMC can be safely done. The MR may not worsen .It may even disappear. Note: Eccentric MR jets are indirect evidence for sub valvular disease. Its very likely to get worsened and may require a mitral valve replacement . Here is patient with severe mitral stenosis, the MR is in all probability safe.   Incidentally this patient also had another antomical adversary , the bulge of IAS into right atrium. This can happen two ways .Septal aneurysm or a normal septum bulging to RA due to raised mean LA pressure.   Miral stenosis with Atrial fibrillation showing the changing mitral inflow jet .   The radius of curvature of IAS bulge Indicates its more of septal weakness that contributes than the raised pressure. There is a small risk in these patients the IAS flap may give way during the procedure and a small ASD may be created .(Hemodynamically may not be significant though) Final message Though there are clear contraindications ,suitability of mitral valve for PTMC is more of a personal experience and confidence.A huge LA, Distorted IAS anatomy, a clot confined to LA appendage are relative contraindication only.  
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: PTMC PTMC -Tips and tricks rheumatic heart disease Uncategorized Source Type: blogs