PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY IN PATIENTS WITH MITRAL-STENOSIS AND COEXISTENT HYPERTHYROIDISM

Percutaneous transvenous mitral commissurotomy (PTMC) was performed su ccessfully without complications in 3 patients with severe mitral sten osis and hyperthyroidism. All 3 patients had pliable, noncalcified mit ral valves. One patient who had been treated with methimazole for 6 mo nths was still in a hyperthyroid state when she presented with intract able congestive heart failure and was found to have severe mitral sten osis. The heart failure improved immediately after PTMC, but the patie nt remained in New York Heart Association functional class 2 until a e uthyroid state was achieved with I-131 therapy. In the other 2 patient s, hyperthyroidism was unsuspected at the time of PTMC. Unexpectedly s uboptimal symptom improvement led to the diagnosis of hyperthyroidism 1 month after the intervention. In all 3 patients, PTMC resulted in an immediate hemodynamic and clinical improvement. However, complete cli nical improvement occurred only when euthyroid state was achieved afte r antithyroid treatment. The present study suggests that PTMC is a saf e and effective intervention modality in patients with coexisting hype rthyroidism and severe mitral stenosis. The procedure may be considere d a therapeutic option in patients with hyperthyroidism and severe mit ral stenosis.