The early radiologic recognition of mitral valve disease

Abstract

Summary The earliest enlargement of the heart due to mitral valve diseaseis left auricular enlargement. This can best be diagnosed fluoroscopically by examining the patient in the right anterior oblique projection after administering a barium bolus. Even a slight degree of posterior deviation of the esophagus is significant and may occur long before the cardiac outline is otherwise altered. Other methods for determining cardiac enlargement based on calculationsmade from teleroentgenograms and tables of the patients' heights and weights were found to be unreliable in detecting early left auricular enlargement. The frontal silhouette of the heart may retain a normal appearance even when the left auricle is considerably enlarged posteriorly. It is necessary to examine patients with systolic apical or transitory murmurs with these facts in mind. A diagnosis of a functional murmur should not be made if there is roentgenologic evidence of an enlarged left auricle. Neither should a heart be considered normal if the murmurs are transitory or temporarily absent in the presence of an enlarged left auricle.