الفهرس 
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Abstract
Rheumatic mitral stenosis is a common disease in our country. It has been treated since many
years by closed mitral commissurotomy, yet; after the advent of MEV in 1984, many reports
considered it; the treatment of choice in well selected patients.
This study, aimed to find out the effects of MBV on pulmonary artery pressure, Tricuspid
regurge and right ventricular function, immediately after the procedure and on short term follow
up.
from the period of 1990 to 1992, MBV was offered to 25 patients with tight symptomatic mitral
stenosis (11 males, and 14 females), with mitral valve area less than 1.5 cm2 . The age
ranged from 15 to 58 years with a mean of 30.3 ± 10.3 years. 7 patients were in atrial
fibrillation and 5 patients had history of previous commissurotomy.
MBV patients were evaluated before and after the dilatation by clinical examination,
electrocardiogram, chest x ray and echodoppler studies. They were followed up for at least 6
months. They were presented for follow up at
1,3,6,8 and 10 months after MBV with a mean follow up duration of 7 ± 1.7
months. At follow up, all the patients were evaluated by the same pre and post dilatation
studies.
MBV was done by the transvenous antegrade approach using double balloon technique in 22
patients and single balloon technique in 3 patients.
Pre-dilatational assessment aimed at studying pulmonary artery pressure, right ventricular
function and dimensions and tricuspid regurge by the help of echocardiographic doppler
studies. Mitral valve area, transmitral diastolic pressure gradient, left atrial size and
left ventricular function were also assessed. All these parameters were followed up after MBV
for at least six months. Hemodynamic data were obtained from the
Summary And Conclusions- 190
cardiac catheterization laboratory both before and immediately after the procedure.
MBV was found to produce favourable hemodynamic effects as assessed by hemodynamic and
echodoppler studies in the form of significant increase in the doppler mitral valve area (from
0.9 ± 0.15 to 1.98 ± 0.33 cm2), DROP in the doppler transmitral pressure gradient (from 15.5
± 5.3 to 5.5 ± 1.6 mm Hg), DROP in the doppler mean pulmonary artery pressure (from 43 ± 12
to
28 ± 13 mm Hg), regression in the severity of tricuspid regurge, and
increase in the right ventricular ejection fraction (from 41 ± 8% to 46 ± 8%).
On short term follow up (7 ± 1.7 months), improvement in the functional state in most of
patients with presistance of the favourable hemodynamic effects were observed. Pulmonary
artery pressure showed further significant reduction from the post MBV values (28 ± 13 to 23 ±
10 mm Hg). Right ventricular ejection fraction showed further significant improvement (46 ± 8%
to 52± 7%). Significant regression in the right ventricular anterior and posterior wall
thickness was reported on follow up, with no change as regard the right ventricular internal
dimensions. The severity of tricuspid regurge regressed significantly in most of patients. Left
ventricular function showed immediate significant improvement immediately after MBV (56.5 ±
5.5% to 60.6 ± 5.7%) and further improvement had been developed on follow up. (60.6 ± 5.7 to
62.7 ± 6.5%) Left atrial size showed significant regression on follow up. (5.1± 0.9 to 4.6 ± 1.2
em)
3 patients had suboptimal results with post MBV valve area equal to or less than 1.5 cm2 , and
3 patients had restenosis on follow up defined as loss of more than 50% of the gain in the
mitral valve area achieved by MBV. 8 patients developed mitral regurge and 5 patients had
post MBV residual ASD. No other major complication had been encountered.
Right ventricular functional improvement was not influenced by the denovo mitral regurge,
iatrogenic septal defect or mitral restenosis. The functional improvement was more significant
in those with optimal than in patients with suboptimal results.
Summary And Conclusion.<;- 191
Conclusions :
1- MBV in the appropriate patients, in skilled and experienced centers, is the procedure of the
first choice for relief of tight mitral stenosis.
2- Successful MBV results in an immediate favourable hemodynamic effects that is followed by
both subjective and objective improvements.These effects are well maintained on follow up
in most of patients undergoing MBV.
3- Successful MBV results in an immediate improvement in the pulmonary artery
pressure and right ventricular function. Substantial further improvement is expected
to occur on follow up. Significant regression of the right ventricular hypertrophy
in response to successful MBV is also expected to occur on follow up.
4- The severity of tricuspid regurge is expected to regress in most of patients in
response to MBV. This effect supports the concept that most of the tricuspid regurge in
association with mitral stenosis is functional and secondary to pulmonary hypertension.
5- Right ventricular functional improvement is less likely to be influenced by the
unwanted sequelae ofMBV.
6- The complications of MBV are minimal and can be avoided by proper selection of patients
undergoing the procedure. Younger patients, in sinus rhythm, having echo score less than 8 and
with no fluoroscopic calcification are the best candidates for MBV with the least possible
incidence of complications .
So ...; MBV seems to have beneficial immediate and short term hemodynamic effects upon
pulmonary artery pressure, right ventricular function and the severity of tricuspid regurge.
Further studies are still in need to evaluate the long term right ventricular
functional response to successful MBV and its relation to the long term outcome ofMBV.