الفهرس 
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Abstract
Rheumatic heart disease remains a considerable cause of cardiovascular morbidity and mortality in developing countries where two thirds of world’s population lives.
Large number of children and young adults have rheumatic heart disease and nearly a third of these have mitral stenosis. Rheumatic heart disease is the etiology of mitral stenosis in most of the patients.
Over the past decades, rheumatic heart disease (RHD) and its antecedent rheumatic fever (RF) have largely declined from wealthy countries, and the clinical caseload of RHD has shifted to older age groups. RHD has also been dwarfed by ischemic heart disease. Additionally, RF/ RHD control programs were successfully implemented in some low- and middle-income countries during the latter part of the 20th century, prompting the World Health Organization (WHO) and others to downscale their RF/RHD activities by the early 2000s.
Rheumatic mitral stenosis (MS), a delayed complication of rheumatic fever, is the most common etiology for MS worldwide.
Patients with mitral stenosis have prolonged P-wave duration and increased P-wave dispersion (PWD).
P-wave duration and PWD increase progressively in concordance with the progression of mitral stenosis.
P-wave dispersion (PWD) is a noninvasive electrocardiographic (ECG) marker for atrial remodeling and predictor for atrial fibrillation (AF).
The prolongation of intraatrial and interatrial conduction time and the inhomogeneous propagation of sinus impulses have been shown in patients with atrial fibrillation. These are well known electrophysiologic characteristics in patients with paroxysmal atrial fibrillation (AF).
Atrial fibrillation is a complication of mitral valve stenosis that causes several adverse neurologic outcomes.
Percutaneous mitral commissurotomy (PMC) has been used successfully as an alternative to open or closed surgical mitral commissurotomy in the treatment of symptomatic rheumatic mitral stenosis. PMC produces good immediate hemodynamic outcome, low complication rates, and clinical improvement in the majority of patients. Percutaneous mitral commissurotomy is safe and effective and provides clinical and hemodynamic improvement in rheumatic mitral stenosis. Percutaneous mitral commissurotomy is the preferred form of therapy for relief of mitral stenosis for a selected group of patients with symptomatic mitral stenosis.
In this study, we aimed to evaluate the effect of percutaneous mitral commissurotomy on P wave dispersion to assess the risk of atrial fibrillation.
This study is a prospective study which was conducted on 36 patients with significant mitral stenosis (MV Area less than 1.5 cm²) presenting to cardiology department at Ain Shams University Hospital.
The main results of the study revealed that:
The comparison of MVA before and 24 hours postoperatively after PMC, showed that there was significant increase in MVA at 24 hours postoperatively.
All pulmonary artery pressures (Systolic pulmonary artery pressure (SPAP), Diastolic pulmonary artery pressure (DPAP) and Mean pulmonary artery pressure (MPAP)) showed significant improvement in studied patients after PMC.
Both Right ventricular systolic pressure (RVSP) and Right ventricular diastolic pressure(RVDP) showed statistically highly significant improvement in the studied patients after PMC
Mean left atrial pressure (MLAP) showed statistically highly significant improvement in the studied patients after PMC with mean decline of more than 10mmhg. mean right atrial pressure (MRAP) showed non-significant change in the studied patients after PMC.
As regard, left ventricular diastolic pressure (LVDP) and left ventricular systolic pressure (LVSP) showed non-significant change after PMC.
Furthermore, Aortic systolic pressure (Ao SP) Aortic diastolic pressure (Ao DP) and Aortic mean pressure (Ao MP) showed non-significant change after PMC.
The comparison of PWD and LA volume before, 24 hours postoperatively and at two months follow up after PMC, P wave dispersion (PWD) showed significant decrease 24 hours after PMC and two months after PMC. Also, left atrial volume (LA volume) showed significant decrease 24 hours and two months after PMC.
All studied patients were in risk of atrial fibrillation (PWD ≥38mm) before PMC. P wave dispersion returned to normal range in 7 patients (19.4%) 24 hours after PMC and 24 patients (66.7%) after two months after PMC among suited patients.
P wave dispersion (PWD) decreased in 27 patients (75%) 24 hours after PMC and in 33 patients (91.7%) after two months after PMC among suited patients. It was reported that prolonged P-wave duration and increased PWD have been reported to carry an increased risk for atrial fibrillation (AF).
Comparison between Inoue balloon and double balloon techniques regarding MVA, PWD and LA volume before PMC, after 24 hours and after 2 months of PMC, showed that left atrial (LA) volume 24 hours after PMC showed more decrease in patient who was underwent PMC by double balloon technique rather than whose was underwent PMC using Inoue technique, but other outcomes were non-significantly differed between both techniques.
PWD measured before showed highly significant relation with systolic pulmonary artery pressure (SPAP) and significant relation with mean pulmonary artery pressure (MPAP) diastolic pulmonary artery pressure (DPAP). There was also highly significant relation between PWD and right ventricular systolic pressure (RVSP). Also PWD showed significant relation with left atrial pressure (mean LA pressure). However, P wave dispersion (PWD) 24 hours and two months after PMC didn’t show any significant relation with any studied parameters before or after PMC.
In the current study correlation analysis was done between P wave dispersion (PWD) and left atrial volume (LA volume) before PMC, 24 hours after and two months after PMC and showed non-significant relation.
Also, correlation analysis was done between the decrease of PWD and LA volume difference after 24 hours and two months and showed non-significant relation.