This document compares outcomes of percutaneous transvenous mitral commissurotomy (PTMC) procedures performed with or without heparin administration on 552 patients in Bangladesh between 2003-2012. Patients who received heparin (Group 1, n=264) during PTMC were compared to those who did not (Group 2, n=288). Results found no significant differences between the groups in procedural success rates, complications, or in-hospital outcomes and death rates. The study concludes that heparin administration during PTMC does not provide any additional protective effects against embolic events during the procedure or hospital stay.

2. Md. Toufiqur Rahman MBBS, FCPS, MD, FACC, FESC, FAPSIC, FAPSC, FRCP,FAHA1
Syed Azizul Haque MBBS, FCPS, MD, FACC, FRCP2
AAS Majumder MBBS, D.CARD, MD, FACC, FRCP,FESC, FSCAI3
Afzalur Rahman MBBS, MD, PhD, FACC, FRCP4
1.Associate Professor, Department of Cardiology, National Institute
of Cardiovascular Diseases, Dhaka.
2.Professor, Department of Cardiology, Dinajpur Medical College &
Hospital.
3.Director and Professor, Department of Cardiology, National
Institute of Cardiovascular Diseases, Dhaka.
4.Professor, Department of Cardiology, National Institute of
Cardiovascular Diseases, Dhaka.

3. Correspondence to: Dr. Md. Toufiqur Rahman, MBBS, FCPS,
MD, FACC, FESC, FAPSIC, FAPSC, FRCP, FAHA Associate
Professor, Cardiology, Room No.225, North Block, National
institute of Cardiovascular Diseases (NICVD), Dhaka.,
E-mail: drtoufiq19711@yahoo.com; drtoufiq1971@gmail.com

4. Rheumatic fever and rheumatic heart disease continue to be the
major health problem in all developing countries including
Bangladesh. Percutaneous Transvenous mitral Commissurotomy
(PTMC) is an established non-surgical modality for the treatment
of severe rheumatic mitral valve stenosis.

5. To compare immediate and in-hospital outcome of PTMC with
or without heparin administration.

6. The study group included 552 consecutive patients who
underwent PTMC at the National Institute of cardiovascular
Diseases (NICVD), Dhaka and Al –Helal Heart Institute, Mirpur,
Euro-Bangla Heart Hospital, Lalmatia, Dhaka between May 2003
and December 2012. Safety, efficacy and in-hospital results of
percutaneous transvenous mitral commissurotomy were
analyzed in 264 patients with heparin (group 1) and compared
with 288 those of without heparin(group 2). Heparin was
allocated randomly.

8. Parameters Group-I Group-II
P Value
(with heparin) ( without heparin)
N = 264 N=288
Age ( years ) 43 ± 11 44 ± 12
NS
Sex
Male 54 ( 20.2 % ) 48 (16.1 %) NS
Female 210 (80.3 %) 240 ( 84.4 % ) NS

9. Parameters Group-I Group-II P
Value
(with heparin) ( without heparin)
N = 264 N=288
RHD status
MS 144 (55.26%) 174 (60 .13%) NS
MS with MR < 120 ( 44. 74 % ) 114 ( 39.87 % ) NS
Grade –II
NYHA Status
Class 1-II 146 (55.80%) 57 (54. 20%) NS
Class-III-IV 118 (44. 20%) 131 (45.80%) NS
Wilkins Echo
score
<8 159 (60.2%) 169 (58.8%) NS
>8 105 (39.8 %) 119(41.2%) NS
Fluroscopic
Calcium > 2+ 66 (25.0%) 71 ( 24. 8%) NS
Prior
Commissurotomy 57 (22.2%) 67 (23.0%) NS
Mitral Regurgiitation <2 108 (41.2%) 116(40.4%) NS

10. Parameters Group-I Group-II P Value
(with heparin) (without heparin)
N = 264 N=288
MVA ( cm2
) 0.85 ± 0.09 0.85 ± 0.25 NS
Transmitral gradient-MPG
mmHg ) 26 ± 03 22± 06 NS
LA size ( mm ) 51 ± 05 48± 10 NS
LA Pressure
(mmHg) 52 ±08 47±09 NS
Aortic Pressure
mmHg ) 87±11 94±11 NS

11. Parameters Group-I Group-II P Value
(with heparin) (without heparin)
N = 264 N=288
MVA ( cm2 ) 1.76 ± 0.07 1.76 ± 0.19 NS
Transmitral gradient-MPG
(mmHg ) 08 ± 02 07 ± 04 NS
LA size ( mm ) 47 ± 05 45 ± 05 NS
LA Pressure (mm Hg) 18 ± 7 12 ± 5
Aortic Pressure (mmHg) 96 ± 03 98 ± 08 NS

12. Characteristics Group-I N = 264 Group-II N=288 P
Value
Procedural success 240 ( 90.9 % ) 264 ( 91.6 % ) NS
Procedural death 0 0 NS
In hospital death 02 ( 0.75 % ) 01 ( 0.3% ) NS
MR grade—Post PTMC
2 + 10 ( 03.8%) 08 ( 02.8 % ) NS
3 + 10 ( 03.8% ) 04 ( 01.4 % ) NS
Left to right shunt (ASD ) 20 ( 07.5 % ) 16 ( 05.5 % ) NS
AV block 0 0 NS
Local vascular 30 ( 11.4 % ) 24 ( 08.4 % ) NS
complications like pain,
hemorrhage, hematoma
Thromboembolism 03 ( 0.9 % ) 2( 0.8 % ) NS
Pericardial 03 ( 0.9 % ) 03 ( 0.10 % ) NS
temponade (Haemopericardium)

13. Heparin administration during PTMC is not associated with any
additional protective effect against embolic events during
procedure and in-hospital stay.