الفهرس 
Anatomy of the Mitral ValveOnly 14 pages are availabe for public view
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Abstract
The developed countries witnessed a dramatic decline in the incidence of RF and the prevalence of RHD in the 20thcentury; however, this has continued to be major health care concern in the developing countries among both children and adults. RHD is endemic in Egypt, a high proportion of patients with RHD are young with mean age in our study of 38.7±10 years.
In Egypt, rheumatic heart disease was rampant in 1950’s. There is slow and steady decline in the prevalence of the disease but not reaching the ideal goals. Unfortunately, if affects young adults in their most productive years adding to the economic burden of the involved families and the nation as well.
Minia Governorate is considered as one of the most populous governorates in Egypt and being one of the poorest in the country. RF is the main cause of rheumatic heart disease in children of school age up to 18 years and among females in childbearing period.
In the period between January 2013 and January 2015, 60 patients with rheumatic mitral valve diseases (stenosis, regurgitation or both) were admitted to Cardiothoracic Surgery Unit, Minia University Hospital, and underwent MVR. These patients classified into two groups; group A (30 patients underwent MVR with mechanical valves, female to male ratio was 2:1 and mean age was 39.6±10 years), and group B (30 patients underwent MVR with tissue valves, female to male was 4:1 and mean age was 38±10.5 years).
Echocardiography had been used in this study for measurements of cardiac chamber dimensions and for the assessment of LV performance. TTE was done during hospital stay, early postoperative, 3months postoperatively, 6 months postoperatively and 1 year postoperatively. Data collected from TTE include: function of prosthetic valve, pericardial effusion or not, LA, LVEDD, LVESD, postoperative outcome of DeVegta’s TR, EoA and EF.
MR accounts for 60% of patients in group A and 43.3 % of patients in group B. MS accounts for 10% of patients in group A and 23.3% of patients in group B. Combined MR and MS accounts for 30% in group A and 33.3% in group B. Almost all of the studied patients had severe mitral valve lesions, with no statistically significant difference between both groups.
The tricuspid regurgitation was found in 43.3 % of all studied patients (53.3 % of group A and 33.3% of the group B) and all of them undergone DeVega’s tricuspid annuloplasty. They showed postoperative significant reduction of the severity of TR, as 56.2% of patients in group A and 50% in group B have no tricuspid regurgitation postoperatively. Postoperative mild tricuspid regurgitation was found in 18.8% of patients in group A and 30% in group B. Moderate tricuspid regurgitation was present in 25% of patients in group A and 20% of patients in group B.
There was no statistically significant difference between both groups regarding intraoperative data, postoperative ventilation time, ICU stay, duration of hospital stay, postoperative use of inotropes, pacing, postoperative blood transfusion and frequency of pericardial and pleural effusion.
There was no statistically significant difference between both groups regarding decrease in LA diameter and improvement of LVEDD, LVESD, gradient across prostheses and EF estimated by early postoperative, 3rd month, 6th month and 1st year postoperatively but there was significant statistical difference between both types of prostheses regarding effective orifice area in sizes 27 and 29 in favor of mechanical valves .
There was statistically significant difference between both groups in regard of postoperative complications. The overall complication was 33.3% in group A and 13.3% in group B. In group A the observed complications were prolonged ventilation in 3.3%, low cardiac output syndrome (LCOS) in 13.3%, re-operation for bleeding in 3.3%, anticoagulant-related bleeding events in 16.6%, wound infection in 6.7%, cardiac tamponade in 3.3%, new-onset of arrhythmia in 6.7%, and neurological deficit in 3.3%. While in group B, the observed complications were LCOS in 10%, wound infection in 3.3%, cardiac tamponade in 3.3%, new-onset of arrhythmia in 3.3%.