الفهرس 
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Abstract
Rheumatic heart disease continues to be a major health problem in developing countries with poor financial resources. Mitral stenosis is a common expression of rheumatic insult.
The Inoue balloon is the current method of choice of dilatation of mitral stenosis and has proven itself comparable to surgical commissurotomy and is preferred by most operators because of its ease of use compared with other available techniques. However, the development of significant MR remains as infrequent yet very important complication. Also its limiting success in dilating calcified and deformed valves restricts its use to a selected population of mitral stenosis patients with a large proportion of these patients eventually requiring some form of surgical intervention instead.
The aim of this study was to evaluate the degree of change in mitral regurgitation before; after PBMV and at short term follow up and to find out the most sensitive and applicable predictors of development of mitral regurgitation (MR) following percutaneous mitral commissurotomy using Inoue balloon technique.
This study was carried out on 40 patients with severe MS who underwent PBMV from April 2014 to May 2015. They were divided into two main groups:
..group (A) including 28 patients who didn’t develop increase in the grade of MR at follow up period.
..group (B) including 12 patients who developed ≥ one grade increase in MR at follow up period.
Each patient was subjected to full history taking, clinical examination, standard 12-lead resting ECG, laboratory investigation of acute phase reactants, transthoracic and transoesophageal echocardiography and PBMV. Results before, after and at short term follow up were compared in the 2 groups.
In our study; the overall incidence of MR was (13patients) 32.5% including that of SMR 7.5%.No patient developed severe MR≥3/4 grade (immediately after PBMV)
; At follow up; the overall incidence of MR was 30% including that of SMR 10%. from the 10% of SMR; only 5% (2patients) had severe MR grade III.
In the present study, the forward stepwise logistic regression analysis identified the presence of pre procedural MR grade I as the only independent predictor for development of MR after PBMV (P=0.01).
In our study, there is a successful balloon valve enlargement; around two fold increase in MVA and an associated dramatic fall in peak (PG) & mean (MG) transmitral pressure gradients, left atrial pressure and pulmonary artery pressure. These hemodynamic benefits are mirrored in post procedural improvement in the patients’ symptoms (NYHA Fc). Despite the increase in MR in group (B), there was no significant difference between the two groups in the symptomatic and haemodynamic improvement after PBMV.
Conclusion:
The presence of pre procedural MR grade I was the only independent predictor for increase in MR after PBMV.
Despite of this increase in MR following PBMV, Sustained symptomatic benefit [up to 3 months] and an improved functional status can be achieved by PBMV in this subset of patients.
Recommendations:
A wider use of Inoue balloon dilatation is recommended in every cath. Lab. based on its successful results; in addition to the begnin outcome of the mild to moderate increase in MR that may occur following this procedure.
Further studies are recommended to evaluate long- term results and predictors for developing MR following PBMV on a larger scale of patients as this study was done on 40 patients only which made the statistical results not conclusive.
Limitations of the study:
The sample size was small and larger further prospective studies are needed to address definite conclusion.
We tested MR following PBMV using only Inoue technique but not other techniques such as multitrack balloon technique.
Also, we did not evaluate other new MV scoring systems such as Cormier’s (100) grading of mitral valve anatomy, that developed by Rifaie et al. (102) and the first scoring system using real-time transthoracic 3DE (RT3D-TTE) introduced by Anwar et al(104).
The long term results of PBMV in these patients and whether they will require further intervention in the future is yet to be answered by a long term follow up studies in the future.