THE IDEAL TECHNICAL PROCEDURES IN DIAGNOSIS AND THERAPY OF MITRAL VALVE STENOSIS

Abstract

This research was performed to study the role of diagnostic investigations (Chest X-ray) also (Echocardiography) in the diagnosis of mitral valve stenosis and how to dilate it by Inoue balloon under (fluoroscopy) and explain the different effects of the disease upon thirty two patients of approximately 18 to 46 years old, 8 of them were males and the rest were females. The percentage of them are (25% males and 75% females). The study (Chest X-Ray) show that the cardiomegaly appeared in 68.75% of patients and 91% of them there is a left atrial enlargement also 62.5% have a left ventricular enlargement, 47% of them the carinal angle widened, the kerly,s B lines appeared in 25%, edema appeared in 53% of them, the other diseases, such as: (small heart, hyper inflated lungs, emphysema, right sided pneumothorax, pneumonia, right sided pleural effusion and encysted pleural effusion) appeared in 18.75% of them. X Also the study (Echocardiography) show that 91% of the patients appeared that the left atrial enlarged and appeared normal in size of 9 % of them, also 78.125% of the patients have a severe mitral stenosis . 12.5% of them have a moderate stenosis.9.375 % of patients have a mild stenosis . 3.125 % of patients have a severe mitral regurgitation (severe MR) through the mitral valve and the same percentage (3.125%) have a moderate regurgitation (moderate MR ), 21.5% of them have a mild regurgitation (mild MR), 12.875% have a trivial regurgitation (trivial MR) and the huge percentage of them 59.375% have not regurgitation (No MR ) . The study of echo shows that in all of the patients there is no clot in the left atrium (100%) the dilatation of mitral valve or percutaneous transluminal mitral commissurotomy (PTMC) could not done if there is any left atrial clot because the clot may obstruct the way of the catheter and if it fragmented propagate with the blood stream until to reach the brain and causes many problems. The study done to measure the pulmonary artery pressure (PAP) by the echo show that it is not normal in all the patients, 00% because all of them complain of mitral stenosis. 34.375 % have a mild pulmonary artery pressure, 21.875% moderate and 43.75% have a severe pulmonary artery pressure. Also the study under (Fluoroscopy) to dilate the mitral valve show that the length of the patients (145mm-160mm) resembled 62.5%, (160mm-180mm) take 34.375% and (180mm-200mm) has a 3.125%. The balloon size used for dilatation, the size (24mm) 9.375%, (26mm) 65.625%, (28mm) 25% and (30mm) not used so that resemble 00%. The number of inflations as follow, single inflation 59.375%, double inflations 25% and graded inflations 15.625%. XI The cathetrization show that 6.25% of the patients have a severe mitral regurgitation (severe MR), 3.125% have a moderate mitral regurgitation (moderate MR), 18.725 % have a mild mitral regurgitation (mild MR) and the same percentage of them have a trivial mitral regurgitation (trivial MR) and there is a huge amount of the patients have not any mitral regurgitation (No MR). The study show that the transmitral gradient before dilatation between (06mmHg-14mmHg) was 31.25%, (15mmHg-23mmHg) 59.375% and (24mmHg-32mmHg) 09.375%. And hence we measured the transmitralgradient after the dilatation and we noticed that it decreased to (00mmHg) 18.75%, (02mmHg-04mmHg) 62.50% and between (05mmHg-08mmHg) was 18.75%. Also we measured the pulmonary artery pressure (PAP) before the dilatation and we found that no there is no normal (PAP) in all patients . it is mild in 06.25%, moderate in 56.25% (it is the highest percentage) and a severe in 37.50% of them. After dilatation the pulmonary artery pressure was normal in 18.75% of the patients, mild in 43.75% (it is the highest percentage), moderate in31.25% and a severe in 06.25% of them. The complications appeared in tow patients 06.25% and no there is no complications in the rest 93.75%. Finally the results were good in 93.75% of patients and not good in 06.25% of them. XI