Degenerative Mitral Stenosis: A Case-Based Review

Figures

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  Figure 1. Two-dimensional TTE zoomed apical 4-chamber view, without (left) and with (right) color flow Doppler of the mitral inflow, demonstrates severe MAC (∗) and leaflet calcification (#) with associated proximal diastolic flow acceleration (A). Continuous-wave Doppler spectrum demonstrates an increased mean TMG of 10 mm Hg (B).

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  Figure 2. Two-dimensional TEE midesophageal apical 4-chamber view (0°), diastolic phase, demonstrates severe MAC (∗) with calcification of the mitral leaflets (#) and restricted leaflet opening (A). Continuous-wave Doppler spectrum across the mitral inflow demonstrates a normal TMG of 3 mm Hg (B). Spectral ghosting (mirroring artifact) is seen and should be avoided when tracing. The LVOT was measured in the apical 3-chamber, midsystolic view (120°) inner edge to inner edge at the hinge points (blue double arrow) while avoiding the calcification (∗) on the anterior mitral leaflet (C).

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  Figure 3. Three-dimensional TEE acquisition and multiplanar, diastolic reconstruction demonstrates the MV leaflets in 2 orthogonal planes (A, B), short-axis leaflet tip display (C), and volume-rendered reconstruction in the surgeon's view orientation from the perspective of the LA (D).

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  Figure 4. Two-dimensional TTE parasternal long-axis view (A) and apical 4-chamber (B) diastolic images demonstrate moderate posterior MAC (∗). The continuous-wave Doppler spectral display of the mitral inflow obtained from the apical 4-chamber view demonstrates an increased TMG of 9 mm Hg (C).

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  Figure 5. Three-dimensional TEE acquisition and multiplanar, diastolic reconstruction demonstrates the MV leaflets in 2 orthogonal planes (A, B) and short-axis leaflet tip display (C), which allows for direct planimetry (MVA = 4.4 cm2). A corresponding CCT-derived short-axis slice of the MV leaflet tips (D) during diastole demonstrates a similar MVA by planimetry (MVA = 4.4 cm2).

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  Figure 6. Etiology, outcomes, and associations of DMS. ESRD, End-stage renal disease; LV, left ventricle; HOCM, hypertrophic cardiomyopathy; MR, mitral regurgitation; TR, tricuspid regurgitation.

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  Figure 7. Proposed algorithm featuring summary of steps for echocardiographic evaluation of DMS. CW, Continuous wave.