الفهرس 
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Abstract
Mitral stenosis (MS) still results in significant morbidity and mortality worldwide.(1). Percutaneous balloon mitral ”valvuloplasty” commissurotomy (PMC), first described by Inoue and his colleagues in 1984. (2) This invasive, nonsurgical procedure is safe and effective therapeutic modality in selected patients with rheumatic MS.(3,4) Right ventricular (RV) function abnormalities play an important role in the development of clinical symptoms and the overall prognosis of patients with MS as RV dysfunction occurs early before the systemic venous congestion develops, so it has been shown to be a major determinant of clinical outcome.(5) Severe pulmonary hypertension (PH) is present in about 38% of severe MS cases.(6) Pulmonary vascular disease frequently complicates long standing MS and may significantly influence prognosis.(7,8) Non-invasive estimation of pulmonary vascular resistance (PVR) correlates strongly with invasive measures at both normal and elevated pulmonary pressures. (9)
Aim of the work: assess the effects of successful PMC on PVR and RV functions, immediately and after 6 month using new Doppler echocardiographic indices.
Patient and methods: This study was done in Cardiology department, Zagazig University on 50 patients; 45 females (90%) & 5 males (10%)) with isolated moderate and severe rheumatic MS underwent successful PMC. All of the following parameters were measured before PMC, Immediately after PMC and after 6 months of PMC using transthoracic echocardiography: Mitral valve area (MVA), peak diastolic pressure gradient (PDPG), mean diastolic pressure gradient (MDPG), pulmonary acceleration time (PAT), mean pulmonary artery pressure (MPAP), tricuspid regurge velocity (TRV), right ventricular systolic pressure (RVSP), right ventricular ejection fraction (RVEF), right ventricular outflow time velocity integral (RVOTTVI), right ventricular outflow tract fractional shortening (RVOTfs), tricuspid annular plane systolic excursion (TAPSE) and pulmonary vascular resistance (PVR).
Results: There was highly significant difference concerning regression of RVSP (f=93.95, p<0.01), regression of MPAP (f=132.33, p<0.01), recovery of RVEF (f=124.25, p<0.01), improvement of TAPSE (f=118.95, p<0.01), improvement of RVOTfs (f=62.44, p<0.01) and regression of calculated PVR (f=122.78, p<0.01) when they were compared before, immediately after and after 6 months of PMC. The strongest predictor of increase in RVEF was the increase in RVOTFS. While the decrease in TRV. was the strongest predictor of decrease in RVSP and decrease in PVR.
Conclusions: PMC has proved its efficacy in treatment of MS with favorable valve morphology and succeed to maintain the gain achieved in MVA. It has a very favorable impact in the form of progressive and sustained improvement of RV functions, regression of pulmonary artery pressure and recovery of PVR on short term and after 6 months of follow up. Regression of TRV was strong predictor for recovery of PVR and RVSP while improvement of RVOTFS was a strong predictor of recovery of RVEF.