الفهرس 
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Abstract
• The relatively small number of the patients is one of the limitations of this study.
• Using only 2 D echocardiography in assessing LA function and not incorporating more sensitive methods like 3D or speckle tracking echocardiography may be considered another limitation of the present study.
• Only 14 out of 70 patients with atrial fibrillation were included in our study. So, further studies on patients with rheumatic mitral stenosis in atrial fibrillation and the likelihood of improvement of their left atrial function after valvotomy are required.
• Our study aimed at evaluating the LA function of patients 1 year after BMV, therefore further studies with longer term follow-up periods are needed for better assessment of left atrial reverse remodeling following successful percutaneous mitral valvotomy.
CONCLUSION
• Balloon mitral valvuloplasty, which is the treatment of choice for rheumatic mitral stenosis, has excellent immediate and long-term outcome resulting in a significant regression of LA volume accompanied by a significant improvement of LA volumetric functions.
• Wilkins score ≤ 8, age ≤ 35 years, normal sinus rhythm and balloon -annulus ratio >1 and < 1.1 are good predictors of improvement of LA function and dimensions at the long term follow up post BMV.
SUMMARY
R
heumatic heart disease is one of the most common forms of cardiac diseases worldwide, particularly in developing countries, where it remains the second most common cause of cardiovascular morbidity and mortality after atherosclerotic vascular disease.
Mitral stenosis (MS) is the most common valve lesion seen in chronic rheumatic heart disease. MS in adults is almost always due to a post-rheumatic inflammatory and degenerative disease that fuses the mitral commissures and thickens the chordae. chronic pressure overload due to the stenosis, and atrial inflammation secondary to rheumatic carditis, lead to LA and LA-appendage dilation and fibrosis of the atrial wall and, consequently, an impairment of the LA contractile function.
Balloon Mitral Valvuloplasty (BMV) is considered the treatment of choice for patients with hemodynamically significant MS where successful BMV reduces the size of the left atrium, and improves left atrial function in patients with MS.
The purpose of the current study was to determine the impact of BMV on the long-term outcome and clinical course of LA function.
The study included 70 patients with symptomatic moderate or severe mitral stenosis, undergoing percutaneous balloon mitral valvotomy using 2 balloon-technique who were subjected to thorough history taking, clinical examination and 2D echocardiographic assessment with measurement of LA mechanical function using LAFI formula.
The results have shown an immediate significant improvement of all echocardiographic parameters of mitral stenosis (MVA, MPG and RVSP) and also an immediate marked improvement in all LA diameters, areas, volumes and LA functions post BMV.
Compared to the immediately post BMV results, the results at the long-term follow up (1 year or more after BMV) have shown a significant improvement of LA function index with a significant improvement of LAESV, LAESVI and LA transverse diameter.
The results have also shown a significant improvement of some LA parameters at long-term follow up in the wilkins score ≤ 8 group, age ≤ 35 years group, sinus rhythm group and balloon -annulus ratio >1 group.
Therefore, BMV has excellent immediate and long-term outcome resulting in a significant regression of LA volume accompanied by a significant improvement of LA volumetric functions.
Wilkins score ≤ 8, age ≤ 35 years, normal sinus rhythm and balloon -annulus ratio >1 are good predictors of improvement of LA function and dimensions at the long term follow up post BMV.