Author’s Reply

To the Editor,

The Wilkin’s valve score was not the main topic of our study. As we mentioned in our initial segment of the paper (Introduction), we wanted to see beyond the Wilkin’s score (1). It does not mean that we wanted to challenge the Wilkin’s scoring system. The work that Wilkin’s et al. (1) did is unmatchable. It is well established and has so much worth. The writer correctly mentioned that we used the Wilkin’s score for the selection of our patients in both groups and that they were having a score of <8. The problem was that despite careful selection using the Wilkin’s score outcome in number of patients is used to be suboptimal. This is the crux of our study. We wanted to see if there was anything else that would be useful to improve our outcome besides Wilkin’s score. Therefore, by endorsing the Wilkin’s score in the double balloon (Bonhoeffer) (2) technique at the same time, we tried to see beyond that and reported this in our study. This is the reason we did not touch the numerical values of the Wilkin’s valve score. It was neither our objective nor interesting to explore the thing widely investigated and reported elsewhere in literature.

In our institution, we usually perform transesophageal echocardiogram (TEE) in every patient who is going to undergo percutaneous transluminal mitral commissurotomy (PTMC), especially if the left atrial appendage is not visible on transthoracic echocardiography (TTE). Although these echo findings were included in our patient’s selection criteria, we did not mention it in detail because it was not included in our methodology of PTMC. It is needless to mention that the assessment of the valve structure by TEE was also conducted in the echo department before the selection of patients for PTMC. In fact, a detailed echo study was the prerequisite for patients who were considered for PTMC. Unfortunately, our echo department was not equipped with 3D echo at that time.

It was correctly stated that the calculation of the Iung and Cormier score (3) would make the report more interesting. However, we think that it needs thorough study and a detailed account. To keep the article simple and within the limits of word count, we left it for further studies. We are thankful for the advice and will definitely be looking our data again in this respect. However, it shows that the author of the letter agreed with our claim that a lot of work can be done to improve the outcome of balloon mitral commissurotomy and that we need to look beyond the Wilkin’s score.