The evaluation of mitral stenosis through echocardiography is not really very complicated. The primary view was that are involved in determining the mitral valve area and the severity of mitral stenosis of the parasternal long axis view, parasternal short axis view and through haemodynamic measurements.
In the parasternal long axis view, the anterior mitral valve leaflet assumes a hockey-stick shaped due to the thickening and restriction of the valve leaflets. This doming occurs because of elevated left atrial pressures in combination with a low diastolic pressure within the left ventricle. This appearance is quite classic and should never be missed.
In the parasternal short axis view, mitral valve planimetry can be performed at the level of the tips of the papillary muscles. The maximal area of mitral valve opening during diastole can be easily measured provided the views are clear. Excessive calcification can sometimes distort image quality.
The current recommendations suggest that a mitral valve area of < 1 cm² falls in the category of very severe mitral stenosis. This is often in combination with a diastolic pressure halftime of ≥ 220 ms. Associated with very severe mitral stenosis is left atrial enlargement and elevated pulmonary artery systolic pressure of >30 mmHg.
A mitral valve area of less than 1.5 cm² is severe mitral stenosis. Often, the diastolic pressure halftime would be >150 ms. There will be associated left atrial enlargement and elevated PASP as well.
Remember that you can also use the Wilkins classification when describing the mitral valve movement.
Doppler measurements are extremely useful when determining the mitral valve area. The pressure halftime is the most commonly used method that is derived from mitral valve haemodynamics. It basically describes the time that is required for the gradient between the left atrium and the left ventricle to reduced to one half of its initial value.
However, pressure halftime may not be accurate in the presence of conditions such aortic regurgitation where there is premature closure of the anterior mitral leaflet and alteration in the transmitral gradient.
In the parasternal long axis view, the anterior mitral valve leaflet assumes a hockey-stick shaped due to the thickening and restriction of the valve leaflets. This doming occurs because of elevated left atrial pressures in combination with a low diastolic pressure within the left ventricle. This appearance is quite classic and should never be missed.
In the parasternal short axis view, mitral valve planimetry can be performed at the level of the tips of the papillary muscles. The maximal area of mitral valve opening during diastole can be easily measured provided the views are clear. Excessive calcification can sometimes distort image quality.
The current recommendations suggest that a mitral valve area of < 1 cm² falls in the category of very severe mitral stenosis. This is often in combination with a diastolic pressure halftime of ≥ 220 ms. Associated with very severe mitral stenosis is left atrial enlargement and elevated pulmonary artery systolic pressure of >30 mmHg.
A mitral valve area of less than 1.5 cm² is severe mitral stenosis. Often, the diastolic pressure halftime would be >150 ms. There will be associated left atrial enlargement and elevated PASP as well.
Remember that you can also use the Wilkins classification when describing the mitral valve movement.
Doppler measurements are extremely useful when determining the mitral valve area. The pressure halftime is the most commonly used method that is derived from mitral valve haemodynamics. It basically describes the time that is required for the gradient between the left atrium and the left ventricle to reduced to one half of its initial value.
However, pressure halftime may not be accurate in the presence of conditions such aortic regurgitation where there is premature closure of the anterior mitral leaflet and alteration in the transmitral gradient.
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