Echocardographic Findings in Different Types of Mitral Regurgitation

Forty-eight patients with mitral regurgitation were studied by echocardiography to establish differential diagnostic features. Six patients with rheumatic mitral insufficiency manifested broad and bright echoes from the anterior mitral leaflets and slowed EF slopes. In the majority of patients with prolapse of the mitral valve leaflets due to rupture or redundancy of the chordae tendineae, a posterior sagging of the CD portion of the thin mitral leaflet echoes was evident. Cases with anterior leaflet rupture revealed increased rate and amplitude of anterior cusp opening with a spiked E point. Eight patients with posterior ruptured chordae tendineae were noted to have a paradoxical diastolic anterior motion of the posterior mitral leaflet. Eight instances of mitral insufficiency due to papillary muscle dysfunction manifested a flat CD segment and characteristic double diamond-shaped pattern of the leaflets, lying within an enlarged left ventricular cavity. In two patients with mitral insufficiency associated with calcification of the mitral annulus, a thickened, intense echo was seen posterior to the leaflets. Echocardiograms taken in the patients with severe mitral insufficiency also demonstrated enlarged left ventricular end-diastolic dimensions, increased stroke volume, and increased amplitude of septal motion. The ejection fraction was usually normal, but in 11 it was reduced, suggesting impaired left ventricular function. Echocardiography is an extremely useful technique in evaluating patients with mitral insufficiency, delineating the etiology and severity of the disease, and aiding in grossly assessing left ventricular function.