Abstract
Determining the severity of mitral stenosis (MS) is important for both prognostic and therapeutic reasons. The mitral valve area (MVA) can be measured by planimetry, pressure half-time, continuity equation, and proximal isovelocity surface area methods. In this study, we propose a novel yet simple, independent measure of MS severity–the mitral leaflet separation (MLS) index. This new index could be a useful surrogate measure of the MVA. This index would also help when there is a discrepancy between severities of MS estimated by existing methods, in the presence of atrial fibrillation and in the presence of mitral regurgitation.
Highlights
Rheumatic mitral stenosis is an acquired progressive valvular heart disease characterized by diffuse thickening of the mitral leaflets, fusion of the commissures, and shortening and fusion of the chordae tendineae, which occur as a sequel to acute rheumatic fever
We evaluate a novel yet simple, independent measure of mitral stenosis (MS) severity—the mitral leaflet separation (MLS)
There was inverse correlation with mean gradient and area detected by planimetry (r = −0.643) (Figure 1)
Summary
Rheumatic mitral stenosis is an acquired progressive valvular heart disease characterized by diffuse thickening of the mitral leaflets, fusion of the commissures, and shortening and fusion of the chordae tendineae, which occur as a sequel to acute rheumatic fever. Determining the severity of mitral stenosis (MS) is important for both prognostic and therapeutic reasons. Two-dimensional (2D) Doppler echocardiography is presently the gold standard method for assessment of severity of MS [1]. The mitral valve area (MVA) can be measured by planimetry, pressure halftime (PHT), continuity equation, and proximal isovelocity surface area methods [2, 3]. Direct measurement of MVA by planimetry is accurate but is highly operator dependent and sometimes laborious. The reliability of the pressure half-time method is affected by changes in preload or left ventricular compliance. The transmitral gradient is well correlated with MS severity. Transmitral gradient and continuity equation depend on transvalvular flow and may be affected by cardiac output and presence of mitral regurgitation
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