achieved MVA  1.5 sq cm and 10 patients developed at least moderate to severe MR.6 patients were sent for emergent surgery due to leaflet tear (n¼4)or severe commissural MR (n¼2)with low output state. Of the patients sent for emergent surgery due to severe MR, calcium nodule /irregular thickening of leaflet were significant associations (p< 0.001).Higher grades of SVF correlated with higher pre-PTMC pulmonary pressures and portended a worse PTMC outcome. Using regression analysis and Pearson’s rank relation, correlation coefficients for post-PTMC poorer out- comes were significantly stronger for higher grades of SUBVALVE DISEASE (r¼ 0.76 )and LEAFLET NODULAR CALCIFICATION(r¼0.72) than the composite score (r¼0.67 )as also the other two variables in the score(0.51 for M,0.47 for T). Conclusion: Presence of calcium nodules on mitral leaflets, irregular leaflet thickening of leaflets with thick/thin areas and presence of severe subvalve disease were more predictive of poorer outcomes of PTMC, than were mobility of valve or thick- ening as per Wilkins’ scoring criteria. Among the above, worse subvalve disease related to poorer gain of area immediately post PTMC as well as higher residual gradients. Presence of calcium nodules on leaflet as well as irregular leaflet thickening were more predictive of give-way during balloon dilation and leaflet tear ,leading to severe MR mandating immediate surgical in- tervention. Correlation of serum Vitamin D levels with severity of rheumatic mitral valve calcification Jamal Yusuf, P. Jothinath, Saibal mukhopadhyay, Vimal Mehta, Vijay Trehan, Sanjay Tyagi GB Pant Hospital, New Delhi, India Background: Rheumatic mitral valve calcification (RMVC) is an active inflammatory process. Balance of pro and anticalcific fac- tors in the local milieu of the valve determine its susceptibility to calcification.Vitamin D has been shown to have anti-inflamma- tory and anticalcific effects .Till date no study has assessed its levels in patients of RMVC compared to noncalcified rheumatic valves. Aim: To assess serum Vitamin D level in patients of RMVC compared with non calcified valves and see correlation between serum Vitamin D level and severity of mitral valve calcification assessed by (TTE) transthoracic echocardiography ( wilkins cal- cium score WCS). Method: 30 patients each of rheumatic mitral valve with no calcification (WCS 0, group 1) , mild calcification(WCS1 or 2, group 2) and severe calcification( WCS 3 or 4,group 3) have been studied ( study is ongoing and 55 patients will be enrolled in each group). Serum calcium, phosphorus, alkaline phosphatase, parathor- mone and 25 OH vitamin D (immunoassay Elecsys 2010 Roche, Germany) were assessed. Results: Mean age of three groups were similar (29.32±9.8 in group 1 , 31.68±7.23 in group 2, 32.75±9.83 in group 3 , p ¼ NS) . Serum Ca, P, ALP, PTH, and ESR were also similar in all 3 groups (p¼NS). Serum 25 OH vitamin D was siginificantly lower in group 3 (11.06±3.85 ng/ml , p <0.001 vs group 1) and group 2 (21.86±8.49 ng/ ml,p < 0.001 vs group 1) compared to group 1 (29.42±9.4 ng/ml ) . A siginificant inverse correlation was identified between Vitamin D level and severity of calcification (r ¼0.79, p<0.001). Vitamin D level in non- calcified valves was near normal (normal value  30 ng/ml). Conclusion: This is first study to show significant reduction in vitamin D level in patients with RMVC . Thus a link may exist between 25 OH vitamin D and calcification process in RMVC and supplementation of oral Vitamin D to maintain normal level may prevent or attenuate progressive valvular calcification. Correlation of mitral valve area (MVA) with dyspnea in mitral stenosis Swati Sharma, Preeti Fargose, Reshma Puranik, V.K. Joglekar Department of Medicine, Grant Medical College, JJ Hospital, Mumbai, India Background: It is observed that in MS dyspnea may not always correlate with MVA. Study was carried out to access correlation of MVA with severity of dyspnea. Methods: Two hundred cases of pure MS in NYHA class I to IV comprised material of this study. Detailed clinical evaluation followed by ECG, XRAY and ECHO were done in all cases. Results: Correlation of NYHA class to MVA is as follows- NYHA class MVA<1sq.cm. MVA1-1.5sq.cm MVA1.5-2sq.cm. Tot I (108) 2 8 98 108 II (56) 1 45 10 56 III (22) 2 16 4 22 IV (14) 10 2 2 14 Total 15 71 114 200 Disparity is observed between MVA and MYHA class of dyspnea. Left atrial (LA) compliance , pulmonary vascular resistance (PVR), stretchability of mitral valve ring play an important role. Thus NYHA class I dyspneais observed in MVA less than 1 sq.cm. When LA wall is compliant whereas with mild MS, NYHA class III or IV dyspnea is observed if LA wall is non compliant. Conclusions: It appears that dyspnea is not a reliable indicstor of severity of MS. Echocardiography as a basic criterion for diagnosis of rheumatic fever and rheumatic heart disease A. Lalchandani, Mayuri Agarwal, S. Verma, T. Midha, M. Godara, A. Garg, P. Singh, B.P. Priyadarshi, M. Naveen, Razi, P. Abhishek PG Institute of Medicine, GSVM Medical College, Kanpur, India Background: To study the role of 2D Echo Doppler in diagnosis of Rheumatic fever and Rheumatic heart disease and to compare echocardiography as a diagnostic criteria compared to Jones Criteria of rheumatic fever (RF) and rheumatic heart disease (RHD). Methods: There were 32 patients included in study and were fol- lowed over a period of one year from December 2011 to November 2012. Patients with any complaints related to criteria for diagnosis of rheumatic fever and rheumatic heart disease whether present or past were included and divided into two groups - Those with positive echocardiographic evidence of carditis in patients diag- nosed as ARF and RHD and those without echocardiographic ev- idence of carditis in ARF and RHD. Those with clinical evidence of indian heart journal 66 (2014) s1 es143 S135 brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by Elsevier - Publisher Connector