IN THE NAME OF GOD CASE PRESENTATION BY: Dr.Isa Khaheshi Cardiovascular Research Center, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

41 y/o woman presented with h/x of ascites , fatigue and mild lower limbs edema from several months ago whom was undergone medical treatment with Lasix,Aldactone,Digoxine,lisinopril PMH:h/x of MVR 12 years ago due to severe MR RF:-

PH/X: Heart: S1,S2 irregular rhythm Lungs: clear, no rales Abdomen: soft, no organomegally,no significant shifting dullness Extremities: no edema

Ultrasonography of abdomen: *Ascites , *Liver congestion due to right side HF

TTE,TEE: EF=60%, MODERATE RVE,MODERATE RV SYSTOLIC DYSFUNCTION, NON-CAOPTED TV LEAFLETS WITH SEVERE TR,PAP=30,TV ANULUS=39 MM WELL SEATED MECHANICAL MV (MPG=2.6,PPG=17.6,PHT=80)

What is your decision about severe TR????

Thanks a lot for your attention