الفهرس 
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Abstract
PBMV has become a safe and effective therapeutic option in a wide range of patients with mitral stenosis, and thus appears to be an attractive therapeutic alternative to surgery in patients who are good candidate for commissurotomy. PBMV can be done safely in cardiac catheterization labrotaries percutaneously without general anesthesia, with relatively low risk and patients can leave the hospital 24 hours after the procedure.
Both the short and long term results of percutaneous mitral valvuloplasty were similar to or even better than results of surgically closed mitral commissurotomy. However, some complications had been reported with PBMV but those complications are low especially with increased operator experience.
The aim of this study was to see the effect of PBMV in mitral valve area immediate improvement, regression during one year after initial improvement and the factors affecting both improvement and regression. Also the study evaluated NYHA improvement post PBMV. The study aimed to see the mortality and complications of the procedure and need for revalvotomy and surgery throughout one year of follow-up.
All patients were subjected to:
Full history taking, gerenal examination, local examination, resting 12 leadsECG, chest roentography and echocardiographic examination before percutaneous mitral valvuloplasty and within 24 hrs after the procedure and one year later.
Echo was used to assess the mitral valve area using direct planimetry left parasternal short axis view LPSXV. Also patients were subjected to (TEE) before percutaneous balloon mitral valvuloplasty to exclude left atrial thrombi, assess mitral valve score. Then subjected to PBMV.
27 patients, were selected from the in patient ward at the Sudan International cardiac centre, in Sudan from first of January 2009 to last of December 2009 with clinical diagnosis of RHD, MS, with wilkin score suitable for percutaneous balloon mitral valvuloplasty. Their ages range from 27 to 56 yrs and (X± SD) = 38 ± 7.73 yrs and sex distribution 18 for Female, representing 66.7% of the total, and followed for one year.
The result was successful PBMV as shown by improvement of the mean of the initial mitral valve area from 0.97± 0.21 cm2 to 2.17 ± 0.33 cm2 immediately after the procedure ( MVA2 ) and to 1.98 ± 0.32 cm2 (MVA3) after one year. This increment of MVA which was obtained by direct planimetry using echocardiography, left parasternal short axis view, from MVA1 to both MVA2 & MVA3 was echocardiograhically and statistically significant with a p-value of > 0.001. The mitral valve area showed decremental slope from MVA2 to MVA3, and although this area reduction was statistically significant with a p-value of > 0.001 but it is echocardiographically insignificant because the mean mitral valve area after one year (1.98 ± 0.32 cm2) is still around 2.00 cm2. This result give a clue to the effective ness of PBMV as an effective procedure in increasing the mitral valve area effectively immediately and even in along term manner.
Correlation between the initial mitral valve area MVA1 & mitral valve area percentage of change % in univariate analysis showed that both MVA1% & MVA2% were inversely correlated to MVA1, while MVA3% is directly correlated to MVA1.Those correlation were statistically significant at the three level of comparison with p- value < 0.01 at level 1 & 2 and < 0.05 at level 3. But by using multivariate analysis the initial mitral valve area showed no effect on MVA3%.
Relating the wilkin score to the MVA% in univariate analysis by dividing patients into two groups (R) group with wilkin score up to 8 and S group with score more than 8) showed that MVA1% & MVA2% are higher in the group of wilkin score (R) compared to group with score (S). and those relations were statistically significant with p– value < 0.001. Also, MVA3% was higher in group with wilkin score (R) compared with a group of score (S).That relation was statistically significant with p–value < 0.05. But by using multivariate analysis wilkin score showed no effect on MVA3%.
Regarding correlation of age to MVA%, No correlation was observed. Also patients were divided into two groups 9 were male and 18 were female to show the effect of sex on MVA% and it was clear that the no relation was observed.
It was clearly seen that NYHA status was improved after the procedure. Patients with NYHA pre class II were 4 in number, 14.81% of total,and all of them improved post PBMV procedure to NYHA class less than II. Patients with NYHA pre class III were 16 in number, 59.26% of total, and 14patients (87.5 %) of them improved post PBMV procedure to NYHA class less than II, 1 patient (6.3%) improved to NYHA class II and only one patient persist as NYHA class III. Patients with NYHA pre class IV were 7 in number, 25.93% of total, and 5patients (71.4 %) of them improved post PBMV procedure to NYHA class less than II, 2 patient (28.6%) improved to NYHA class II and no patient persist as NYHA class IV. Table 15 showed that NYHA post was improved markedly with 23 patients representing 85.2% of total (27 patients) became less than NYHA II compared to 0 patient (0.00%) before, 3 patients (11.1%) became class II compared to 4 patients (14.81%) before, 1 patient (3.7%) became class III compared to 16 patients (59.26%) before, No patient (0.0%) became class IV compared to 7 patients (25.93%) before. This improvement was statistically significant with p–value < 0.001.
In our study the only complication that had developed was mitral regurgitation in 2 cases out of 27 with ratio of 7.4 %.Through out one year of follow up, there was no deaths, no need for revalvotomy & there was only one case under went mitral valve replacement 4 months later with a ratio 3.7% of the total, reflecting the safety of the procedure. So, our study recommend PBMV to patients with MS and favourable mitral valve morphology and no contraindications for balloon valvotomy