الفهرس 
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Abstract
Unlike the Western world in which rheumatic disease is becoming rare in the past few decades, the disease remains endemic in the developing world as the most common cause of mitral stenosis (MS) and regurgitation (MR).
Almost 1/3 of rheumatic patients suffer from pure MS, while the remainder suffers from combined MS and MR (Left heart disease). Both conditions lead to pulmonary hypertension (PH) in advanced stages, which is associated with poor prognosis. Unfortunately, there is no treatment for PH and the best approach is managing the underlying condition.
Pulmonary hypertension is a pathophysiological hemodynamic condition defined as an increase in mean pulmonary arterial pressure (mPAP) of ≥25 mmHg at rest. In PH due to left heart disease, both systolic and diastolic dysfunctions are usually present. Therefore, a retrograde transmission of left cardiac pressures to the pulmonary venous and arterial beds occurs, inducing an initial vasoconstriction, followed by pulmonary vascular remodelling (irreversible).
Doppler echocardiography is the best tool for screening purposes. However, more invasive measurements, such as pulmonary wedge pressure (PWP) or left ventricular end-diastolic pressure may be required to confirm the left cardiac origin of condition.
This study is a descriptive prospective study which was conducted to assess early outcome after mitral valve replacement in patients with pulmonary hypertension. it included forty eight patients undergoing mitral valve replacement at the Cardio-thoracic Surgery Department, Suez Canal university hospital in the period between 1st July 2017 and 3th june 2018, who were divided into two groups:
• group (A) 25 patients: with mild to moderate pulmonary hypertension (25 ≤ sPAP < 55 mm Hg).
• group (B) 23 patients: with severe pulmonary hypertension (sPAP ≥55 mm Hg).
Preoperative transthoracic Doppler echocardiography was performed in all patients, systolic pulmonary arterial pressure (sPAP), left atrium diameter (LAD), left ventricular end-diastolic dimensions (LVEDD), left ventricular end systolic dimensions (LVESD), fraction shortening (FS) and left ejection fraction (LEF), were evaluated and compared. Preoperative right ventricular systolic pressure (RVSP) was significantly lower in group (A) compared to group (B) (P value <0.05). However, preoperative assessment showed that the mean left ventricular end diastolic dimension (LVEDD), left ventricular end systolic dimensions (LVES), left ejection fraction (EF), fraction shortening (FS), and left atrium diameter were not significantly different between both groups.
Patients with severe pulmonary hypertension were given sildenafil orally for six weeks and echocardiography was done prior to surgery. It was found that pulmonary artery pressure was insignificantly different before and after sildenafil administration.
The results showed that mitral valve pathology was non-significantly different between the two groups. However, number of patients who had grade III IV tricuspid regurge was significantly higher in group B than group A.