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Introduction: Right ventricular (RV) systolic dysfunction occurs early before clinical systemic congestion in patients with mitral stenosis (MS). Conventional echocardiographic techniques have some limitations in the assessment of RV function. Aim of the work: To evaluate the role of two dimensional (2D) longitudinal systolic strain and strain rate imaging in detection of subclinical RV systolic dysfunction in patients with moderatesevere MS. Patients and methods: Fifty patients with isolated MS (moderate-severe) and 30 healthy control subjects constituted the study population. Conventional echocardiography, pulsed wave tissue Doppler imaging (TDI) of the tricuspid annulus and 2D longitudinal segmental and global RV systolic strain (RV-GLS) and strain rate (RV-GLSr) measurements were obtained. Results: Patients with MS had significantly lower RV-GLS and RV-GLSr compared to control subjects (À19.67 ± 6.23 vs. À24.19 ± 3.25, P < 0.001, and À1.49 ± 0.87 vs. À1.91 ± 0.56, P = 0.02, respectively). Conclusion: Patients with MS had significantly lower 2D RV-GLS and RV-GLSr compared to control group. 2D RV-GLS and RV-GLSr imaging appear to be useful in detection of subclinical RV systolic dysfunction in patients with MS.

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Patients with severe AS have evidence of subclinical LV systolic dysfunction despite preserved EF%. 2D speckle tracking appears to be useful in detection of subclinical LV dysfunction in patients with AS.

Iatrogenic coronary artery disease following prosthetic valve implantation is a rare complication. This may result from mechanical injury in the intraoperative period. The use of balloon tip perfusion catheter presumably provides the initial insult with local vessel wall hypoxia. Once the diagnosis of coronary ostial stenosis is established, the procedure of choice is coronary artery bypass surgery. We report a case of a young lady who underwent aortic and mitral valves replacement for infective endocarditis. She was then diagnosed with ostial left main stem coronary stenosis after presenting with atypical symptoms. The patient eventually underwent coronary artery bypass surgery.