Safe MR jets in PTMC : They should be a central jet , can even be little more than mild !

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. Angle of eccentricity  One must realise , the eccentricity of a jet is not very objective .What may appear as central jet in long axis may be wall hugging in 4 chamber view. This is very important to recognise. Further , even central jets can reveal a invisible eccentricity detected only on 3D MR jet reconstruction. One simple way to ascertain central jet is to  check whether the MR jet align in the same angle as diastolic color jets of MS into LV inflow . (Looking carefully ,the diastolic color jets also provide us info about sub-valvular disease ) More anatomical distortion in this patient  Incidentally , this patient also had another anatomical adversary  ie ,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...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: PTMC PTMC -Tips and tricks rheumatic heart disease Uncategorized Source Type: blogs