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

2. 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:-

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

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

6. 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)

7. What is your decision about severe TR????

9. Thanks a lot for your attention