Pulsed doppler echocardiographic study of mitral stenosis

C Thuillez, P Théroux, M G Bourassa, D Blanchard, P Péronneau, J L Guermonprez, B Diebold, D D Waters, P Maurice
1980 Circulation  
The value of pulsed Doppler echocardiography in the assessment of mitral stenosis was studied in a consecutive series of 175 patients before rightand left-heart catheterization. All Doppler recordings were interpreted independently by two observers. Twenty patients had repeat studies to demonstrate the reproducibility of the method. Adequate recordings were obtained in 156 patients. A normal flow pattern was observed in all 41 patients in sinus rhythm without a mitral valve gradient but in none
more » ... of the 51 patients in sinus rhythm with a mitral gradient. In atrial fibrillation the normal pattern was identified in all three patients with no mitral gradient but in none of the 61 with a gradient. Three patterns of mitral valve flow could be distinguished that corresponded to mild, moderate and severe stenosis. The mitral valve gradient in the 36 patients with pattern I was 6.1 ± 1.7 mm Hg (SD) (range 3-10 mm Hg); in 54 patients with pattern II it was 12.0 ± 2.5 mm Hg (range 8-18 mm Hg) (p < 0.001 vs I); in 22 patients with pattern III it was 22.0 ± 2.6 mm Hg (range 18-27 mm Hg) (p < 0.001 vs II). Overlap was observed in only four patients, all of whom had a gradient between 8-10 mm Hg. Mitral valve area was 2.14 ± 0.58 cm2 in pattern I, 1.17 ± 0.33 cm2 in pattern II and 0.67 ± 0.26 cm2 in pattern III (p < 0.001 between all groups). The presence of associated mitral regurgitation in 39 patients and aortic valve disease in 32 patients did not affect the Doppler assessment of mitral stenosis. Thus, pulsed Doppler echocardiography can accurately detect the presence of mitral stenosis and assess its severity. THE NONINVASIVE STUDY of mitral valvular disease has been greatly enhanced by ultrasound techniques. M-mode echocardiography allows recognition of the stenotic valve' and bidimensional echocardiography permits an estimation of mitral valve area.2 Mitral valve flow can be recorded by Doppler echocardiography3 and preliminary results suggest that this technique can provide an estimate of the severity of mitral stenosis.4 The limitations of standard echocardiography in the quantification of mitral stenosis have been recognized8 and the usefulness of the bidimensional approach is being evaluated.9 Pulsed Doppler techniques theoretically provide an alternative approach to this problem. In this study we extended previous work from our laboratory7 to assess prospectively in a large number of patients undergoing cardiac catheterization the accuracy of Doppler echocardiography in detecting and defining the severity of mitral stenosis. Methods Patient Selection A Doppler study of the mitral valve was attempted on the day before right and left cardiac catheterization
doi:10.1161/01.cir.61.2.381 pmid:7351064 fatcat:mva744q7ifa75gzdxyft5xjfne