TT Mitral Stenosis, Moderate

3D quantification of moderate mitral valve stenosis

July 2, 2022
Pages 1 – 3

A 56-year-old female patient (BSA= 1.6 m2) was admitted for a previous diagnosis of “significant”rheumatic mitral valve stenosis. Blood pressure was normal and there was permanent atrial fibrillation. Heart rate= 74 bpm. The symptoms were limited to mild shortness of breath on exertion (NYHA II).
The transthoracic examination showed mild fibrotic thickening of the aortic valve; moderate left atrial dilatation (49 ml/m2); normal LV end-diastolic volume (41 ml/m2) and ejection fraction (61 %); normal mean estimated left atrial pressure (pulmonary regurgitation end-diastolic gradient= 6 mmHg) and pulmonary systolic pressure (21 mmHg); normal right ventricular size and systolic function and mild tricuspid regurgitation.
The mitral valve showed mild fibrotic thickening of the apical portion of the leaflets (Figures 1 and 2) and nodular calcifications of the sub-valvular apparatus; commissure fusion; akinesis of the posterior leaflet and moderate diastolic doming of the anterior leaflet.

Figure 1. 2D parasternal long axis mitral valve
Figure 2. 2D pasternal short axis mitral valve
Figure 3. 2D parasternal short axis, mitral valve
Figure 3. 2D parasternal short axis, mitral valve

The mitral valve planimetry in the short axis showed an area= 1.9 cm2.
The continuous wave Doppler exam showed a mean gradient= 2.2 mmHg (Figure 5) and a calculated area with PHT= 1.68 cm2 (Figures 4-6).

Figure 4. Continuous wave Doppler, apical 4-ch, mitral valve
Figure 4. Continuous wave Doppler, apical 4-ch, mitral valve
Figure 5. Continuous wave Doppler, apical 4-ch, mitral valve
Figure 5. Continuous wave Doppler, apical 4-ch, mitral valve
Figure 6. Continuous wave Doppler, apical 4-ch, mitral valve
Figure 6. Continuous wave Doppler, apical 4-ch, mitral valve