Utility of Mitral Leaflet Separation Index (Mlsi) For Assesing Severity of Mitral Stenosis Before and After Percutaneous Trnansmitral Commisurotomy(Ptmc)
2019
Background: A novel index called the mitral leaflet separation index (MLS index) has shown to be useful
in assessing the severity of Mitral Stenosis (MS). However, studies on use of MLS index in assessing
severity of mitral stenosis in post PTMC setting is limited
Aims: To study correlation of MLSI with severity of mitral stenosis by various method on echocardiography
and catheterization in both pre PTMC and post PTMC setting.
Methods: Consecutive patients of all ages and both sexes with moderate to severe rheumatic mitral stenosis
who underwent successful PTMC from January 2014 to December 2015 were included in the study. The
mitral valve area (MVA) was estimated by the standard 2D echo planimetry and pressure halftime methods.
The MLS index was estimated by measuring the maximal separation of tip of the mitral leaflets in end
diastole in parasternal long axis (PLAX) view and in apical 4-chamber view (A4C). The MS severity was
also assessed by calculating the MVA using Gorlin’s Formula during cardiac catheterization study.
Correlation between MLSI and hemodynamic severity of MS by conventional echocardiography and
catheterization was studied.
Results: 50 patients with moderate or severe mitral stenosis and valve morphology favourable for PTMC
were included in the study. The male-to female ratio is 1: 2.33. The mean age of the patients was 30.64 +
10.62 years. Pre-PTMC, the mean MVA by PHT method was 0.749 + 0.12 cm2 while the mean MVA by
2D method was 0.77 + 0.23cm2
. The mean MV pressure gradient was 14.93 + 1.93mmHg and the mean
MLSI was 6.606 + 1.5 mm. Mean MVA (Gorlin) was 0.735 + 0.1 cm2
. MLS index correlated well with
MVA by planimetry method both in pre-PTMC (r = 0.635; p = <0.0001) and post-PTMC patients (r = 0.49;
p = 0.0004) and overall correlation was r = 0.92 with p < 0.0001
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