An echocardiographic appreciation of rheumatic heart disease: phenotypic variability of valvular involvement and its prognostic implications

Figures

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  Fig. 1. Evolution of echocardiographic techniques in rheumatic heart disease. This figure illustrates the historical progression of echocardiographic imaging from M-mode to two-dimensional (2D), three-dimensional (3D), and contemporary true-view modalities.

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  Fig. 2. Echocardiographic assessment in rheumatic heart disease. This figure illustrates how echocardiography provides a comprehensive and integrative evaluation of rheumatic heart disease, from diagnosis, quantification of severity to decision-making regarding intervention.

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  Fig. 3. Staging of rheumatic heart disease (A–D). This staging framework integrates clinical and prognostic information with echocardiographic findings to provide a comprehensive view of disease severity.

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  Fig. 4. Net atrioventricular compliance (Cn): Doppler-derived assessment and physiological interpretation. Cn is a non-invasive index reflecting the combined compliance of the left atrium and left ventricle. The schematic illustrates that the atrioventricular unit acts as a functional chamber accommodating transmitral flow during early diastole. Higher Cn allows larger volume accommodation with a gradual rise in pressure, resulting in a shallow E-wave deceleration slope, lower left atrial and pulmonary pressures, and better functional status. In contrast, reduced Cn (lower compliance) is characterized by rapid pressure equalization, a steep E-wave deceleration slope, higher left atrial and pulmonary artery pressures, and worse symptoms.