Three Dimensional Versus Two Dimensional Echocardiography in Assessment of Severity and Scoring of Rheumatic Mitral Stenosis.

Study Overview
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Brief Summary
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Although the prevalence of rheumatic fever is decreasing in developed countries, it still affects numerous areas in the non- industrialized world. Untreated mitral stenosis (MS) contributes significantly to global morbidity and mortality. Echocardiography is the main diagnostic imaging modality for evaluation of mitral valve (MV) obstruction and assessment of severity and hemodynamic consequences of MS as well as valve morphology. According to current guidelines and recommendations for clinical practice, the severity of MS should not be defined by a single value but assessed by valve areas, mean Doppler gradients, and pulmonary pressures. Transthoracic echocardiography is usually sufficient to grade MS severity and to define the morphology of the valve. Transesophageal echocardiography is used when the valve cannot be adequately assessed with transthoracic echocardiography and to exclude intracardiac thrombi before a percutaneous or surgical intervention. Three-dimensional transthoracic and transesophageal echocardiographic assessment provide more detailed physiological and morphological information. Current definitive treatment for severe MS involves percutaneous balloon mitral valvuloplasty (PMBV) or surgery. The effectiveness of PMBV is related to the etiology of MS, and certain anatomic characteristics tend to predict a more successful outcome for PMBV, whereas other MV structural findings might suggest balloon valvuloplasty to be less likely successful or even contraindicated. Does 3D echo can add more useful information over 2 D echo that could change treatment decision?

Official Title
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Three Dimensional Versus Two Dimensional Echocardiography in Assessment of Severity and Scoring of Rheumatic Mitral Stenosis.

Conditions
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Mitral Valve Stenosis

Intervention / Treatment
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* Other: 2D Echocardiography
* Other: 3D Echocardiography


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient age range from 18 years to 60 years. Patient with isolated mitral stenosis (except those with mild mitral regurgitation and are candidate for PTMC by 2D Echo evaluation). Patient with normal left ventricular EF patient both in sinus rhythm or atrial fibrillation Exclusion Criteria: Age below 18 years or above 60 years. Patient with another valve lesion or more than mild mitral regurgitation. Patient with impaired cardiac function. Mitral stenosis of other etiology than rheumatic origin

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Mitral Stenosis patient<br> | Other: 2D Echocardiography<br>* Mitral valve area will be determined by 2 D echo-Doppler methods<br>Other: 3D Echocardiography<br>* Patients included in the study will undergo 3D Echo after being evaluated with 2D Echo. Mitral valve area will be determined by real time 3D.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| benefit of 3D echocardiography in mitral stenosis severity | The added benefit of 3D echocardiography over 2D echo in evaluation of rheumatic mitral stenosis severity with pressure gradient | 1 year | 
| benefit of 3D echocardiography in mitral stenosis scoring | The added benefit of 3D echocardiography over 2D echo in evaluation of rheumatic mitral stenosis score | 1 year |