Percutaneous transcatheter mitral commissurotomy (PTMC)

What is PTMC?

PTMC (or mitral balloon valvuloplasty) was developed in the 1990s as treatment for mitral stenosis (a narrowed mitral valve). Since this time, as the prevalence of rheumatic heart disease has declined in the developed world, the procedure has been performed less frequently. Dr Smith and his team have maintained experience of this effective procedure and regularly undertake PTMC for rheumatic mitral stenosis. 

The procedure is performed under general anaesthetic. This enables us to more safely guide the balloon from the right to the left side of the heart (transeptal puncture) and to assess the result after balloon inflation. PTMC is performed at a low risk of approximately 1%, depending on the presence of other medical problems.

Is PTMC an option for me?

PTMC is usually considered in patients with severe mitral stenosis, due to previous rheumatic heart disease. Patients can be unaware that they have had rheumatic heart disease in their past. PTMC can sometimes be seen as option for patients in whom mitral valve surgery is too high risk, but more commonly it is an option to delay or prevent the need for surgery in younger patients or women who wish to conceive.

We will usually recommend a transthoracic echo scan (TTE) and sometimes a transoesophageal echo scan (TOE - with the echo probe in the food pipe) before being certain if PTMC is suitable for you. We look at a number of factors including the degree of mitral valve leak, the pressure difference across the valve and the presence and position of calcium on the valve to decide if PTMC is a good option

How is PTMC carried out?

We normally recommend PTMC is performed without stopping your warfarin or other blood thinner. While under general anaesthetic, a very small incision is made in the groin and a tube placed in the femoral vein. Another small tube is placed in the femoral artery to monitor the pressure during the procedure. Guided by both XRAY and TOE we then cross the wall between the right and left heart (the intra-atrial septum) and advance a small tube into the left atrium which sits just above the mitral valve. The dedicated balloon that has been measured to fit the valve (an Inoue balloon) is advanced across the mitral valve and then inflated to carefully stretch open the valve and reduce the narrowing (stenosis). After the balloon has been inflated and pulled back into the left atrium, we can measure the reduction in pressure (the gradient of stenosis) and assess the valve with the TOE scan. The small tube is removed from the groin and a small dissolvable plug usually placed. You will normally return to the ward within one hour and go home either the same or the following day.

Our Team

Toufan Bahrami

Mr Toufan Bahrami is a senior consultant in cardiac surgery , working at both Royal Brompton and Harefield Hospital, where he treats both NHS and private patients.

He also works at The Harley street clinic in central London .With more than 4000 cardiac operations of which 1500 are minimally invasive procedures over past 21 years, He is the   only consultant in UK expert in all aspects of minimally invasive cardiac surgery including , Mitral , Aortic valve and root and CABG with a longstanding track record.

Saeed Mirsadraee

Dr Mirsadraee’s specialist interest is cardiovascular imaging and in particular imaging of the heart valves, surgical and transcatheter aortic and mitral valve procedure planning, and complex aortic conditions. He is the radiology lead for aortic and mitral imaging at the Royal Brompton and Harefield hospitals. Dr Mirsadraee uses CT images in planning Mitral valve procedures such as minimal access mitral valve surgery, transcatheter mitral valve implantation (eg. Tendyne, Sapien in ring/MAC), cord and left ventricular remodelling procedures (eg. Accucinch, Neocord).

Ali Vazir

Dr Ali Vazir is a consultant cardiologist based at the Royal Brompton and Harefield Hospitals, part of Guy’s and St Thomas’ NHS Foundation Trust. He is also an Honorary Clinical Senior Lecturer at National Heart and Lung Institute, Imperial College London. 

He is an expert in heart failure and echocardiography. He is the clinical lead for heart failure at the Royal Brompton Hospital. He trained in London and was a Post-doctoral research fellow at the Brigham and Women’s Hospital and Harvard Medical School, Boston, USA. He is a principal investigator for several multicenter trials. 

Lauren Connolly

Lauren has worked within the cardiology and cardiac surgery care setting for seven years. In recent years she has worked within the structural heart team as clinical nurse specialist and co-ordinator for the trans catheter team, specifically focusing in mitral and tricuspid valve disease.

Dr Robert Smith

Dr Smith’s specialist interest is Mitral valve disease and interventions. He leads one of the largest structural heart disease programmes in Europe at the world renowned Royal Brompton & Harefield Hospitals. It is also the first centre of excellence for MitraClip in the world.