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Related Concept Videos

Mitral Stenosis I: Introduction01:22

Mitral Stenosis I: Introduction

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Mitral Valve Stenosis (MVS) is a heart condition where the mitral valve narrows, impeding blood circulation from the left atrium to the left ventricle. The etiology and pathophysiology of this condition are multifaceted, leading to a cascade of cardiovascular complications.Causes of Mitral Valve StenosisRheumatic Heart Disease: It is the main cause of mitral valve stenosis, particularly in developing nations. This condition arises from rheumatic fever, an inflammatory illness resulting from...
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Mitral Stenosis III: Medical Management01:26

Mitral Stenosis III: Medical Management

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Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
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Mitral Regurgitation I: Introduction01:20

Mitral Regurgitation I: Introduction

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Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
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Mitral Regurgitation III: Medical Management01:25

Mitral Regurgitation III: Medical Management

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Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
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Mitral Stenosis II: Clinical features and Diagnostic Tests01:23

Mitral Stenosis II: Clinical features and Diagnostic Tests

106
Mitral stenosis is a heart condition in which the mitral valve, which allows blood to flow from the left atrium to the left ventricle, becomes narrowed or stenotic. This narrowing hinders blood flow and leads to clinical symptoms requiring specific medical evaluations and management strategies. The following overview outlines the clinical symptoms, assessments, diagnostic findings, prevention methods, and treatments for mitral stenosis.Clinical ManifestationsDyspnea (shortness of breath): This...
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Mitral Valve Prolapse I: Introduction01:27

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IntroductionThe mitral valve, one of the heart's four valves, regulates blood flow. These valves have flaps that open and close to direct blood properly through the heart and body. During each heartbeat, the flaps open for blood to pass through and seal shut to prevent backflow. Specifically, the mitral valve opens to allow blood flow from the heart's upper left chamber to the lower left chamber. It then closes securely as the lower left chamber contracts to pump blood to the body, preventing...
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Interscallop separations of the posterior mitral valve leaflet: a solution to the 'borderline RHD' conundrum?

Luke David Hunter1, Mark Monaghan2, Guy Lloyd3,4,5,6

  • 1Division of Cardiology, Department of Medicine, Tygerberg Academic Hospital, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa lukehunter1987@icloud.com.

Open Heart
|November 6, 2020
PubMed
Summary

Interscallop separations (ISS) are a common cause of pathological mitral regurgitation (MR) in South African children, often misdiagnosed as borderline rheumatic heart disease (RHD). A detailed valve assessment can improve diagnostic accuracy for RHD.

Keywords:
echocardiographyheart valve diseasesmitral regurgitation

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Area of Science:

  • Cardiology
  • Pediatric Echocardiography
  • Rheumatic Heart Disease

Background:

  • The World Heart Federation (WHF) criteria use Doppler echocardiography to diagnose rheumatic heart disease (RHD), classifying mitral regurgitation (MR) as physiological or pathological.
  • Interscallop separations (ISS) of the posterior mitral valve (MV) leaflet can cause pathological MR, potentially leading to misdiagnosis of RHD.

Purpose of the Study:

  • To determine the prevalence of ISS-related MR in South African children at high and low risk for RHD.
  • To compare the prevalence of ISS-related MR between high-risk and low-risk groups.

Main Methods:

  • A prospective cross-sectional echocardiographic study of 759 school children (aged 13-18) was conducted.
  • Children with MR ≥1.5 cm underwent a comprehensive assessment to determine RHD status and the mechanism of MR.

Main Results:

  • Among 400 high-risk children, 0.5% had definite RHD and 2.75% had borderline RHD.
  • Among 359 low-risk children, 3.9% had borderline RHD.
  • ISS was identified as the cause of isolated pathological MR in 83.3% of high-risk and 78.5% of low-risk children.

Conclusions:

  • ISS is a common finding in South African schoolchildren across all risk profiles.
  • ISS is frequently the underlying cause of pathological MR in borderline RHD cases.
  • Detailed MV assessment focusing on the mechanism of dysfunction can reduce misclassification of borderline RHD.