Introduction: Rheumatic heart disease is responsible for the most prevalent pathological causes of mitral stenosis and is closely coupled with pulmonary hypertension. Balloon mitral commissurotomy as an alternative method for mitral valve replacement leads to a reduction in pulmonary pressure. All grades of pulmonary hypertension usually regress after mitral commissurotomy; however, the insignificant changes of pulmonary artery hypertension following balloon mitral valvuloplasty are not uncommon. Methods: This retrospective observational study was carried out on 160 patients with significant symptomatic mitral stenosis (mitral valve area [MVA] <1.5 cm 2) who underwent successful percutaneous transvenous mitral commissurotomy (PTMC) within 2016-2020 at Shaheed Rajaie Cardiovascular, Medical and Research Center, Tehran, Iran. Results: In this study, 89.4% of the patients were female, and the mean age of the participants was 47.2±12.4 years. Most (74%) patients presented with dyspnea on exertion functional class II. The mean basic MVA was 1±0.20 cm 2 that increased to 1.43±0.23 cm 2, and the mean basic systolic pulmonary artery pressure (PAP) was 43.84±11.93 mmHg that decreased to 35.13±7.7 mmHg. Persistent PAP after successful PTMC was observed in 34% of the patients. This group of patients showed smaller MVA gain and PAP reduction after the procedure. Pulmonary vascular resistance (PVR) > 2 Wood units was correlated to 91.7% of the post-procedural success rate. Conclusion: The PTMC plays an important role in the reduction of PAP; nevertheless, the chronicity and severity of PAP can lead to persistent pulmonary hypertension. The assessment of initial PAP and basic PVR can help select patients with more likely intended results.

Abstract Background: diastolic dysfunction has been reported as a cardiovascular effect of hyperthyroidism, and is also supposed to be a cause of heart failure manifestations in the patients with preserved ejection fraction (EF). Methods: for evaluation of diastolic function in hyperthyroid patients and also diastolic Function during performing exercise stress echocardiography, we conducted this study on 26 newly diagnosed hyperthyroid patients compared to 26 healthy subjects as control group. Diastolic function of the patients at rest was assessed using these parameters as follows: left atrium volume index, tricuspid regurgitation (TR) velocity, mitral inflow early diastolic flow (E wave), tissue doppler of mitral annular velocity (e’), E/e’ ratio, and isovolumic relaxation time (IVRT); and during exercise stress echocardiography, we judged diastolic response by measuring E/e’ ratio and TR velocity at the peak of stress in terms of the American Society of Echocardiography guideline. Results: the mean age of the patients was 39.77±12.0 years old and 53.8 % of them were female. Cardiovascular symptoms among the patients were the followings: palpitation (46.2%), exertional dyspnea (19.2%), and atypical chest pain (7.7%). All the patients had normal diastolic function at the time of resting and there was no significant difference in diastolic parameters between the two groups except for IVRT, which was lower in hyperthyroid patients. Interestingly, no patients developed diastolic dysfunction during exercise stress echocardiography. Conclusion: our finding did not support Hyperthyroidsm associated diastolic dysfunction as a cause of exertional intolerance and dyspnea in the patients with preserved EF.

Background: The incidence of prosthetic tricuspid valve (TV) thrombosis is the highest among heart valves. It can lead to high morbidity and mortality without proper treatment. In this study we sought to report the management and clinical outcomes of patients with mechanical TV thrombosis. Methods: In in a retrospective single-center study, all patients with mechanical TV thrombosis were evaluated from 2006 to 2017. The data on baseline characteristics, management of mechanical TV thrombosis, and the rates of adverse events during follow-up period were assessed. Results: A total of 67 episodes of mechanical TV thrombosis in 42 patients were observed. The mean age of patients was 45.5±14.3 years (19 to 77), and overall two-thirds were female. Thrombolytic therapy (TT) was used in 41 (61.1%), anticoagulant intensification in 15 (22.3%), and surgery as first approach in 11 (16.4%) episodes; subsequently, surgery as the final approach was implemented in 20 (29.8%) episodes. There were a total of 2 (2.98%) in-hospital deaths. Moreover, 2 (4.87%) episodes of retroperitoneal hematoma and 1(2.43%) episode of non-hemorrhagic thalamic infarct in TT group, and 1 (5%) episode of non-hemorrhagic stroke following surgery were developed. The rates of freedom from recurrent thrombosis were 84%, 61%, and 21% at the end of 2, 4, and 10 years, respectively. Survival rates and freedom from chronic valve dysfunction was 93%, 82%, and 75% after 1, 4, and 10 years. Conclusions: The recurrent thrombosis requiring intervention is a major complication of mechanical TV, which underscores individual-approached therapy and close follow-up to improve outcome.