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RHD is still a leading cause of cardiac morbidity and mortality among Sudanese patients with MS as the most frequent lesion in adults.PTMC (if suitable valve and no contra indication) is still the preferred procedure to maintain the native valve and delays the need for MVR.One of the major contra indications is the presence of Grade 2 or > MR.We studied the predictors of MR after PTMC and we found that the pattern of valvular involvement is the most important predictor.