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Congenital mitral stenosis. Anatomical and functional assessment by echocardiography
Insights
Digitised M-mode echocardiography is unreliable for assessing congenital mitral stenosis in children. Two-dimensional echocardiography is more effective for evaluating mitral valve abnormalities and left ventricular inflow obstruction.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Congenital Heart Disease
Background:
- Congenital mitral stenosis presents diagnostic challenges.
- Assessing left ventricular inflow obstruction severity is crucial.
Purpose of the Study:
- To evaluate the utility of digitised M-mode and two-dimensional echocardiography in assessing congenital mitral stenosis.
- To determine the reliability of echocardiographic indices in identifying inflow obstruction.
Main Methods:
- Digitised M-mode left ventricular echocardiography in 9 children.
- Two-dimensional echocardiography in 10 children with congenital mitral stenosis.
- Comparison with cardiac catheterisation data.
Main Results:
- M-mode indices were abnormal in 6/9 children but failed to detect obstruction in 3.
- Two-dimensional echocardiography reliably assessed mitral annular size, valve morphology, and subvalvular apparatus.
- Two-dimensional studies detected combined mitral abnormalities.
Conclusions:
- Digitised M-mode echocardiography is generally unreliable for assessing congenital mitral stenosis.
- Two-dimensional echocardiography is valuable for delineating mitral abnormalities and should be used in congenital heart disease with potential inflow obstruction.
Abstract:
Digitised left ventricular echocardiograms were studied in nine children with congenital mitral stenosis to assess the severity of inflow obstruction. In six children the two prime indices of mitral stenosis were abnormal, with a prolonged time from minimum dimension to 20 per cent dimension change and a reduced peak dimension change during diastole. In three, however, these values did not suggest inflow obstruction, depsite significant gradients at cardiac catheterisation. Two-dimensional echocardiography was performed in 10 children with congenital mitral stenosis to determine the mitral annular size and the morphology of the valve and subvalvular apparatus. The annular size and number of papillary muscles could be assessed along with the detection of combined mitral abnormalities. Two-dimensional studies can reliably delineate the type of mitral abnormality, and should be performed in all cases with congenital heart disease having a high incidence of associated left ventricular inflow obstruction. Digitised M-mode left ventricular echocardiography is in general unreliable in assessing congenital obstruction, though it may be of some value in individual cases.