mvs adult restenotic to 1.2 after 2 trial ballon

SUMMERY OF MEDICAL REPORT
PT.NAME AHMED ABDELRAHEEM ELMAGHRABY
AGE 55 YS OLD .
WORK & LIVE IN GERGA / SOHAG  ( UPPER EGYPT )
C  / O DYSPNEA ON ANY EXECRATION
REPEATED HIGH FEVER & CHEST INFECTION FREQUENTLY   PALPATION
FAMILY HISTORY IRRELEVANT
SPECIAL CHARACTER 1- BLOOD GROUPING (O NEGATIVE)
2- NO SPECIAL RELEVANT HABITS

PAST HISTORY                  1- HEAVY SEVER SMOKER ( UP TO 100 CIGARETTE                                                                                                         PER DAY FOR ABOUT 30 YEARS
2-TEA & COFFEE FREQUENTLY
3- NO HYPERTENSION OR DIABETES OR DRINKING
4- CONTROLLED EPILEPTIC ATTACK WITH TTT  
5- STOP SMOKING & TEA & CAFE SINCE 7 YS

PRESENT HISTORY & REPORT
1. IN JAN. 2007 AN ATTACK(CLINICAL EXAM. ECHO) IN SOHAG OUT CLINIC
A. RESULT
I. MODERATE TO MARKED DILATED LEFT ATRIUM
II. M S (ABOUT 1.4 ) DIAMETER THAT MODERATE TO SEVER
III. EARLY CALCIFICATION CHANGE
IV. NO REGURGE OR INTRACARDIAC THROMBI
B. MEDICAL TTT ONLY ( MURVAN +LASIX +ALDACTONE+CAPOTEN )
2. IN OCTOBER 2007 ANOTHER ATTACK OF PULMONARY EDEMA THAT NEED ADMISSION TO ALMKTAM HOSPITAL IN CAIRO
A. THE SAME RESULT OF PREVIOUS INVESTIGATION PLUS
I. SOME SORT OF TRICUSED REGURGE
II. SEVER A F
B. MEDICAL TTT (ASPOCID . CORDARONN/ LANOXIN /MURVAN )
3. NOVEMBER 2007 AT CARDIOLOGY DEPARTMENT OF ASSULT UNIVERSITY  .. THE SAME RESULT & SYSTOLIC FUNCTION (E.F.  66%)
4. IN JUN 2009  ANOTHER ATTACK( OUT CLINIC PROF DR ESAM ELKADY MD CARDIOLOGY INTERNATIONAL DEPARTMENT NATIONAL HEART INSITITUTE
A. THE SAME RESULT OF PREVIOUS INVESTIGATION PLUS
I. M S  (1.2) CM²
II. TOTAL MITRAL (WILKINS) SCORE = 8/ 16
B. TTT
I. LANOXINE
II. CONCOR 5
III. MAREVAN 3 MG
C. ADVISE FOR  C A & TRIAL PBMV
5. IN MAR 2010 IN SOHAG UNIVERSITY
A. DEALING
I. C A .. FREE
II. TRANSOESPHEGEAL ECO … ORGANIZED OLD THROMBUS IN LEFT VENTRICLE
III. BALLOON M V  VALVOPLASTY

B. RESULT AFTER BALLOONING
I. GOOD RESULT OF PREVIORY PROCESS WITH CARE
II. MILD TO MODERATE M S ( 1.4 CM2 )
III. MINIMAL M R
IV. MILD  P H T ( 33 M)
6. IN JULY 2010 IN SOHAG UNIVERSITY RECURRENT ATTACK … &   M V = 1.1 CM²  REPEATED BALLOONING AT SOHAG UNIVERSITY BY PROF DR OSAMA TAHA HESSAN MD CARDIOLOGY INTERNATIONAL DEPARTMENT NATIONAL HEART INSITITUTE
A. TRANSOESOPHEGEAL ECHO … ORGANIZED THROMBI IN LFT VENTRICLE
B. REPEAT THE SAME PROCESS BY DOUBLE BALLOON
C. THE SAME RESULT AGAIN 1.5 CM2 M V WITH A F
D. TTT . THE SAME
7. SINCE TWO MONTH AGO .. SEVER CHEST INFECTION & DYSPNEA OUT CLINIC ( PROF DR MO AWAD TAG ELDIN ) .. ADVISE
A. CHEST X RAY
B. TTT
I. 4TH GENERATION ANTIBIOTIC
II. FARKOLINE SYRP
III. EPICOPHYLLINE SYRP
8. SINCE ONE MONTH THE C/O AGAIN  . INVESTIGATION AT SOHAG CARDIAC CENTER CARDIOLOGY DEPARTMENT UNDER SUPERVISOR PROF DR ESAM ELKADY M D  CARDIOLOGY INTERNATIONAL DEPARTMENT NATIONAL HEART INSITITUTE
A. INVESTIGATION ECHO & CARDIAC CATHETER
I. ECHOCARDIOGRAPHY
1. M V STENOSIS ( 1.1 CM2 BY 2 D / 1.2 CM2 BY PHT
2. TRIVALVE M R
3. M V SCORE  ( 8 : 9 /16 )
4. SYSTOLIC FUNCTION ( F E 65% )
5. P AS PS ( 62 MMHG)
II. CARDIAC CATHETER
1. NON SIGNIFICANT ATHEROSCLEROTIC  L A D & L C X AT MID O M
2. 50%  ATHEROSCLEROTIC & ECTATIC   R C A  WITH STENOTIC LESION
3. ADVISE MEDICAL TTT & CONTROL RISK FACTOR
9. PRESENT TTT
A. IN ANY ATTACK
I. OF CHEST INFECTION INJECTIONS OF ( 3RD GENERATION ANTIBIOTIC + LASIX + CRYSTALLINE PENICILLIN + ANTIPYRETIC AS PERPHEGAN )
II. IF DYSPNEA OR PULMONARY EDAM INJECTION OF LASIX 40 MG
B. EVERY 15 DAYS LONG ACTING PENICILLIN SINCE 3 YS
C. CARDIAC  TTT NOW ( PLUS EPILEPSY )
I. TONORMIN 50 MG
II. ASPOCID 75 MG PEDIATRIC
III. AXAMIDE TAB OR LASIX
IV. LANOXIN
V. MURVAN 4 MG / DAILY
VI. TEGRETOL 200
VII. DEBAKIN TAB
10. COMMENT
A MALE PT. 55 YS SUFFERING FROM RECURRENT FEVER & CHEST INFECTION WITH SEVER DYSPNEA ON ANY EXECRATION SUFFERING FROM A F HEART WITH M V S (1.1 : 1.2 CM² ) BUT BALLOONING TWICE BUT AFTER EACH ONE M V NOT EXCEED 1.5 CM² & RESTENOTIC AGAIN TO 1.1 : 1.2 CM² & NOW  WITH MILD M V R + TVR + PULMONARY  HYPERTENSION + (NON SIGNIFICANT CALCEFICATION OF M V & OLD ORGANAIZED THROMBUS IN LEFT VENTRICLE SINCE 3 YS )  
BUT ATEROSCLEROTIC C A NOT SIGNGICANT FOR TTT
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PLZ WE NEED YOUR ADIVSE IF A NEW TRIAL OF BALLOONING AT ANY WHERE … OR OPEN HEART now no diastolic dysfunction but p r more than 55