PTMC

(PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY)

Presented By ICL STAFF NURSES

INTRODUCTION

Mitral stenosis is constriction of the mitral valve. Mitral stenosis is common in female patient. Untreated can progress from mild disability in about 5 years. Mitral stenosis can be treated with oral diuretics (Frusemide ), Digitalis, Beta Blockers, anticoagulants and diet restricted in sodium. Mitral stenosis can also be treated surgically or interventionally. PTMC is one of the interventional procedure that can be done to treat mitral stenosis.

PTMC

What is PTMC ? - Percutaneous Tranvenous Mitral Commissurotomy. Result -PTMC produce immediate improvement in haemodynamic and clinical status in most patient. In general there is decrease in transmitral gradient and increase in mitral valve area.

Complications

Death Thromboembolitic event Severe Mitral Regurgitation Transient Heart Block Pericardial Tamponade

CASE STUDY

Mdm X, is a 39 year old woman who works as a Air Traffic Controller at Kuching International Airport for the past 15 years. Eldest child from 3 siblings. Single and staying with her family in Petra Jaya. Main complaint was increased shortness of breath with minimal activity such as climbing up 3 steps of staircase 1 year ago(2005). Went to Polyclinic Mosque Road for treatment and was referred to Medical Clinic for further management. She was seen by the Physician, who diagnosed her as having Mitral Stenosis, after which she was referred to the Cardiology Clinic.

HISTORY

Past medical history : Known case of Bronchiol Asthma since childhood. Presently on MDI Ventolin.and uses only when needed. Not known to have other illnessess. Past Surgical History : None Family History : None of the family members has heart diseases.

NURSING PROGRESS NOTE

Admitted to CTW on the 7/6/2006 at 3pm, accompanied by family members. Observation done. Pre procedure preparation carried out such as shaving, iv line inserted and nil by mouth from 12mn instructed.IV Hydrocortisone 200mg given at 6pm, 12mn and 6am as prophylaxis purpose. Blood investigation such as FBC, PT/PTT, BUSE, INR and GSH taken and send.

NURSING RESPONSIBILITIES

PRE PROCEDURE CARE * Ensure that the patient is adequately prepared for the procedure: Informed consent is taken Blood investigation results are available and within normal range Shaving done for both right and left groins Pt. fasted more than 4 hours. IV brannula is inserted and functioning well. Make sure that any foreign body like dentures are removed. Pt. weight and height are written in the note.

INTRA PROCEDURE CARE

POST PROCEDURE CARE Check ACT (Activated Clotting Time) after the procedure and inform Dr. Give Protamine (Coagulant Drug) as ordered by Dr ACT more than 180 Transfer pt. to the trolley. Check patient vital sign such as BP and heart rate. Recheck ACT after 15 minutes Protamine is given. Off femoral sheath and applied pressure dressing. Monitor puncture site for bleeding and haematoma. Monitor circulation and pulses