Robert J. Ostfeld, MD, MS
Case Presentation Introduction
Valve and Supporting Structure Morphology
LA Morphology, Pulmonary Arterial Pressure, and Right Heart Function Assessment of Mitral Valve Area Conclusion Suggested Reading
0.5 cm lateral to the midclavicular line. Her lungs are clear to auscultation and the rest of her exam is within normal limits. Her electrocardiogram demonstrates normal sinus rhythm with an enlarged left atrium (LA). There are no Q-waves or ST changes. Her chest X-ray has clear lung fields. No double density sign is appreciated.
Mitral stenosis was suspected and an echocardiogram (ECHO) was requested and confirmed the presence of mitral stenosis (Fig. 1; please see companion DVD for corresponding video). Her valve area was calculated as 0.9 cm2 by pressure half-time (P1/2 or PHT) and 0.95 cm2 by planimetry. The mean gradient across her mitral valve (MV) was 10 mmHg. Her LA was enlarged and her pulmonary artery systolic pressure (PASP) was elevated. She had mild (1+) regurgitation. Her MV score was eight. Transesophageal ECHO revealed no LA or LA appendage thrombus and she underwent uncomplicated percutaneous mitral valvuloplasty (PMV). She was asymptomatic on her follow-up visit.
Mitral stenosis occurs when thickened MV leaflets and chordae restrict blood flow from the LA to the left ventricle (LV) during diastole. Ultimately, hemody-namic changes within the LA may lead to an increased
From: Contemporary Cardiology: Essential Echocardiography: A Practical Handbook With DVD Edited by: S. D. Solomon © Humana Press, Totowa, NJ
A 55-yr-old woman presents with a chief complaint of dyspnea on exertion. Her past medical history is significant for gastro-esophageal reflux disease and rheumatic fever. She has no known history of valvular disease. Her only medication use is an occasional antacid. She has not seen a physician in approx 10 yr. Over the past year, she began to experience gradually increasing dyspnea on exertion, and she now becomes short of breath after walking up 7-10 steps. She denies shortness of breath at rest. She also denies chest pain, chest pressure, palpitations, claudication, and syncope. She reports the new onset of two-pillow orthopnea that began 6-8 mo ago. And, she denies paroxsysmal nocturnal dyspnea. Physical exam reveals a well-developed, well-nourished female in no acute distress. Her blood pressure is 116/75 mmHg. Her heart rate is 82 bpm and regular. Her complexion appears ruddy. Carotid pulses are normal and there are no carotid bruits. Her jugular venous pressure measures 9 cm of water with no V-waves. Cardiac exam reveals a diminished first heart sound with a normal second heart sound. An opening snap approx 70 ms after the second heart sound is audible along with a grade 2/4 diastolic rumble with presystolic augmentation at the apex. Her point of maximal impulse is
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