Assessment of Contraindications to Percutaneous Mitral Commissurotomy (PMC) in Abidjan Heart Institute, Côte d'Ivoire

• Published in: Bulletin de la Société de pathologie exotique (1990) Vol. 112; no. 4; pp. 187 - 189
• Main Authors: Niamkey, J T, Yao, H, Traoré, F, Ekou, A, Angoran, I, Koffi, D N B, Kadio, M, Anzouan-Kacou, J B
• Format: Journal Article
• Language: French
• Published: France 2019
• Subjects: Hôpital; Rétrécissement mitral rhumatismal; Afrique subsaharienne; Contre-indications; Commissurotomie mitrale percutanée; Abidjan; Echocardiographie doppler
• ISSN: 1961-9049
• DOI: 10.3166/bspe-2019-0102

Rheumatic mitral stenosis is still common in sub-Saharan Africa. The aim of this study was to evaluate the clinical and echocardiographic contraindications to the realization of percutaneous mitral commissurotomy (PMC) in Abidjan Heart Institute. We conducted a prospective, transversal and analytical study in the Exploration Unit from March 30, 2017 to March 30, 2018. Mitral stenosis was severe with an average anatomical surface area of 0.87cm , an average gradient of 13.7 mmHg and an upstream repercussion (dilatation of the left atrium (78 ml/m ); moderate dilatation of the right atrium (22.3 cm ) and average pulmonary arterial hypertension (PAH) of 55 mmHg). The main clinical contraindications were a history of rest dyspnoea at 66.7%, permanent atrial fibrillation at 53.3 % and clinical manifestations of severe PAH in 40 %. Unfavourable anatomy (95.7 %) evaluated by scores of Wilkins, Cormier and especially Echoscore revisited; bicommissural fusion (95.7 %) and severe aortic valvulopathy (31.1%) were the main barriers in transthoracic echocardiography. In multivariate analysis after linear regression, valvular anatomy, as assessed by the various scores, was significantly related to low socioeconomic status (p=0.018), level of education (p=0.04), severity of mitral stenosis evaluated by the mean gradient (p=0.033) and the impact on the left atrium (p=0.015). Mitral stenosis presents several clinical and echocardiographic contraindications. Adverse anatomy is the main obstacle and is related to low socio-economic status, educational level and severity of stenosis.