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avoiding major metabolic abnormalities with respectively.Bad
satisfactory renal function. Detubularization of the
ascending colon and caccum with tapering of the
terminal ileum and tunneled tenial implants of the
ureters have resulted continent cutaneous urinary
reservoir. In total 10 patients were included and
follow-up period was for a period of 6 months to 5
years. One year after surgery overall day and night
continence rate was in 70% patients, some leakage
at day and night in 30% cases and no patient
developed day or night incontinence. The mean
capacity of the pouch was 530 ml at 12-18 months.
Pouch pressure at full capacity was 16 cm H 20 at
18 months. Indiana pouch provides better attention
for urinary diversion in developing countries as it
is well accepted, economically more suitable and
relatively easy to construct, with good results in
terms of continence and reduced complications
with satisfactory renal function.
281 CHOUDHURY , A.K.; IQBAL, F.M.;
ALAM, S.; ZAMAN, M.A. (Cardiology Dept.,
NICVD, Dhaka); MOMENUZZAMAN, (Dept.
of Cardiology, NHF, Dhaka). COMPARISON OF
OUTCOME BETWEEN PERCUTANEOUS
BALLOON AND SURGICAL CLOSE MITRAL
COMMISSUROTO MY IN THE CONTEXT OF
ECHOCARDIOGRAPHIC MITRAL VALE
MORPHOLOGY IN BANGLADESH. Bang. Med.
J., 2006, 35(2), 42-48.
To compare the outcome of the procedure we
carried out a prospective well matched
comparative observational study on 123 patients of
symptomatic mitral stenosis having 60 patients in
each group. Three patients were rejected due to
procedural complications and technical failure in
PTMC group. Age range of both groups were 12-
55 years, mean (±SD) age was 28.83 + 9.33 years.
Out of 120 patients, 41 (34.2%) were male and 79
(65.8%) were female. Before procedure, 29 (48.3
%) and 32 (53.3 %) patients were in NYHA class
III of PTMC and CMC group respectively.
Total Wilkins score was in the range of 4-10. Mean
(±SD) of total Wilkins score were 6.43+1.53 and
6.30+1.33 in PTMC and CMC group
respectively. Good commissural morphology
(score 0-1) were present in 38 (63.5%) and 36
(60%) in PTMC and CMC group
83
commissural morphology
(score 2-3) were present in 22 (26.7 %) and. 24
(40 %) in PTMC and CMC group respectively.
There was also no statistically significant
difference of MR echo score (Padial score)
distribution between PTMC and CMC patients
before procedures (P=0.071).
Transoesophageal (TEE) was done in suspected
patients of left atrial (LA) thrombus having giant
LA and atrial librilation, but none had LA
thrombus in both group.
Mitral valve area increased from a mean (±SD)
of 0.80±0.16 and 0.79±0.15 to 1. 94 ± 0.24 and
1. 92 ±0.26 in PTMC and CMC groups
respectively.
NYHA class improved by class 1 or more in
most patients in both groups. There were 2(3.33
%) cases of cardiac temponade due cardiac
perforation in PTMC group, of which one need
repair and CMC and another was managed
conservatively. There were also 3 (5%)
patients in PTMC and 1(1. 66 %) patient in
CMC developed peripheral thromboembolism
and one patient (1.66%) developed
arteriovenous fistula in PTMC group. Mitral
regurgitation grade III. developed in 3 (5%)
patients and one patient (1.66%) in PTMC and
CMC respectively having no statistical
significance.
There was no procedure related death,
emergency mitral valve replacement (MVR) and
significant ASD in their series. So, the
immediate outcome after PTMC and CMC were
excellent and were statistically significant. But
there was no significant difference in terms of
outcome between the two procedures.
Total Wilkin's score and total commissural
morphology score were found to be most
important preprocedural variable associated with
the outcome. Total MR-echo score (Padial
score) was well correlated with postprocedural,
development of mitral regurgition.
At mide-term follow-up, these results were well-
sustained with further reduction of mean pressure
gradient and LA diameter.