الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Rhecmatrc heart drsease rs common disablrng illness in Egypt.
The rT’rtral valve being the commonest valve affected. Mitral
stenosrs is the commonest sequelae of rheumatic fever.
The natural history of tight mitral stenosrs shows that
progressive hemodynamic and clinical deterioration occur tilt total
disabrlity .
Medical treatment though alleviates symptoms, is still not the
radical treatment for such patients . Instead, closed or open
commissurotomy is needed inorder to increase the mitral valve
area and to reduce the left atrial pressure , thus the clinical
condition can be ameliorated Indeed, closed mitral
commissurotomy remains a reliable surgical technique for the
treatment of mitral stenosis, and it results in tong term
hemodynamic and clinical improvement .
In this country, closed mitral commissurotomy is preferred to
the open tecnique because the former is intended with less
morbidity, mortality and costs.
However, there is a recognized incidence of restenosis after
mitral commissurotomy regardless of the technique used. Moreover
, the resultant fibrosis due to pericardiotomy and chest wall
scarrrng increase the risk of repeating valvotomy .