الفهرس 
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Abstract
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SUMMARY & CONCLUSIONS
Two hundreds and twenty six cases were studied. 105
were chronic rheumatic heart patients (54 melon and 51
females), 59 were active rheumatic heart patients (24 males
and 35 females), 46 were normal cases (21 males and 25 females) and 16 were having acute follicular tonsilitis (8 males and 8 females).
Alpha 1-antitrypsin was found to be normal in 144 patients (63.7 %), high in 69 patients (30.5 %) and low in 13 patients (5.8 %)• Age and sex factors are statistically exluded from this comparison.
Mean level of al-AT was found to be significantly higher in the group of rheumatic fever(371.9mg/d1.)than in the group of chronic rheumatic heart disease (287.6 mg./dl.)
Serum level of al-AT among chronic rheumatic heart patients are not affected by age, sex, age of patient on the first attack of rheumatic fever, duration of illness, recurrence of rheumatic activity, multiplicity of lesions nor type of dermatoglyphic pattern.
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Serum level of al-AT among chronic rheumatic heart patients is not affected by different clinical presentatios
in the form of valve lesion, chamber enlargement, pulmonary hypertension or arthralgia.
Serum level of al-AT among active rheumatic heart patients is not affected by different clinical presentations in the form of carditis, arthritis and /or chorea.
Serum level of al-AT is highly elevated during inflammatory process and could be considered as a diagnostic test besides ESR, CRP and ASOT. It returns to its original level after subsidence of inflammatory process.
Aetiology of rheumatic heart diseases on the basis of congenital deficiency of al-AT could not be proved in our work. We can say that, the pathogenesis of valve lesions following an acute attack of rheumatic fever could not be attributed to al-AT deficiency and another pathogenesis may be considered, possibly on immune base.
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Lastly, we can propose a difference in the
pathogenesis between collagen disorders (proved to be related to al-AT) and rheumatic heart diseases (proved to be not related to al-AT) and this may put rheumatic heart diseases in a different group other than collagen disorders.
We can conclude that lack of correlation between low level of al-AT and progress, degree and severity of valvular damage shows that chronic heart valvular affection is not solely inflammatory process, but other factors work in the process of cardiac affection following rheumatic fever.