{"id":46490,"date":"2021-06-27T05:38:31","date_gmt":"2021-06-27T00:08:31","guid":{"rendered":"https:\/\/johnsonfrancis.org\/professional\/?p=46490"},"modified":"2021-06-27T05:38:31","modified_gmt":"2021-06-27T00:08:31","slug":"assessment-of-mitral-stenosis-by-echocardiography","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/assessment-of-mitral-stenosis-by-echocardiography\/","title":{"rendered":"Assessment of mitral stenosis by echocardiography"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/t78v6LWCBjE\" title=\"YouTube video player\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen=\"\"><\/iframe><\/p>\n<h2><span style=\"color: #008000;\">Assessment of mitral stenosis by echocardiography<\/span><\/h2>\n<figure id=\"attachment_27721\" aria-describedby=\"caption-attachment-27721\" style=\"width: 700px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-27721 size-full\" src=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2016\/09\/ms2.jpg\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" srcset=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2016\/09\/ms2.jpg 700w, https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2016\/09\/ms2-300x104.jpg 300w\" alt=\"Colour Doppler Echocardiogram in Mitral Stenosis\" width=\"700\" height=\"243\"><figcaption id=\"caption-attachment-27721\" class=\"wp-caption-text\">Colour Doppler Echocardiogram in Mitral Stenosis<\/figcaption><\/figure>\n<p>Right panel shows the parasternal long axis view. Doming of the anterior mitral leaflet is seen well and has the appearance of hockey stick. This appearance is classical of rheumatic mitral stenosis. Paradoxical movement of the posterior mitral leaflet is also visible. Normally posterior mitral leaflet moves posteriorly in diastole. Here there is a paradoxical anterior movement due to commissural fusion. Left atrium is dilated. Left panel shows parasternal short axis view. The mitral orifice is seen within the cross section of the left ventricle. The anterior and posterior leaflets are seen in cross section and are thickened; the commissures are fused. Parasternal long axis view will give an assessment of the subvalvar apparatus. Subvalvar fusion may result in poor results after valvotomy as they can produce secondary obstruction beyond the valve. Parasternal short axis view is used for quantitating the severity of mitral stenosis by using planimetry to measure the mitral valve orifice. Commissural fusion and calcification if present can be seen well on PSAX view. Trans mitral gradient is better assessed in apical four chamber view by Doppler. Associated tricuspid regurgitation if present, can be seen on apical four chamber view, which will also help in estimating the right ventricular systolic pressure from the TR.<\/p>\n<figure style=\"width: 500px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2009\/07\/MS-PSAX1.jpg\" alt=\"Fish mouth appearance in mitral stenosis on echocardiogram\" width=\"500\" height=\"306\"><figcaption class=\"wp-caption-text\">Fish mouth appearance in mitral stenosis on echocardiogram<\/figcaption><\/figure>\n<p>Parasternal short axis view in mitral stenosis, showing the \u201cfish mouth appearance\u201d of the mitral orifice in cross section.<\/p>\n<figure id=\"attachment_28779\" aria-describedby=\"caption-attachment-28779\" style=\"width: 943px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-28779 size-full\" src=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2019\/02\/normal-mitral-valve-annotated.jpg\" sizes=\"auto, (max-width: 943px) 100vw, 943px\" srcset=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2019\/02\/normal-mitral-valve-annotated.jpg 943w, https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2019\/02\/normal-mitral-valve-annotated-300x277.jpg 300w, https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2019\/02\/normal-mitral-valve-annotated-768x709.jpg 768w, https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2019\/02\/normal-mitral-valve-annotated-140x130.jpg 140w\" alt=\"Normal mitral valve cross section for comparison\" width=\"943\" height=\"870\"><figcaption id=\"caption-attachment-28779\" class=\"wp-caption-text\">Normal mitral valve cross section for comparison<\/figcaption><\/figure>\n<p>Normal mitral valve cross section for comparison showing anterior and posterior mitral leaflets widely separated. Scallops of mitral leaflets are also visible, more clearly in the posterior leaflet. Read <a href=\"https:\/\/johnsonfrancis.org\/professional\/carpentier-nomenclature-of-mitral-leaflet-scallops-2\/\">Carpentier nomenclature of mitral leaflet scallops<\/a>. The leaflets of normal mitral valve are thin, pliable, non calcified and open well in diastole, with valve area of 4-6 square centimeters. Opening of a normal mitral valve may be reduced in low cardiac output states, even without significant mitral stenosis.<\/p>\n<figure id=\"attachment_36902\" aria-describedby=\"caption-attachment-36902\" style=\"width: 1200px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-36902 size-full\" src=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2010\/05\/RHD-MS-PSAX-view1.jpg\" sizes=\"auto, (max-width: 1200px) 100vw, 1200px\" srcset=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2010\/05\/RHD-MS-PSAX-view1.jpg 1200w, https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2010\/05\/RHD-MS-PSAX-view1-300x214.jpg 300w, https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2010\/05\/RHD-MS-PSAX-view1-1024x731.jpg 1024w, https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2010\/05\/RHD-MS-PSAX-view1-768x548.jpg 768w, https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2010\/05\/RHD-MS-PSAX-view1-140x100.jpg 140w\" alt=\"Echocardiogram in mitral stenosis showing commissural fusion\" width=\"1200\" height=\"857\"><figcaption id=\"caption-attachment-36902\" class=\"wp-caption-text\">Echocardiogram in mitral stenosis showing commissural fusion<\/figcaption><\/figure>\n<p>Parasternal short axis view showing mitral valve in cross section and anterolateral and posteromedial commissures. The valve leaflets are thickened and the commissures are fused. The cut is slightly oblique as a good cut should appear circular. It is often difficult to get a good circular outline of the mitral valve due to varying anatomical features of the chambers and cardiac position. Ideally the smallest full circle should be taken to planimeter the valve area. If it is not a full circle, the subvalvar pathology may be measured as the valve orifice. If the smallest full circle is not taken, it will be the valve proximal to the severest stenosis (valve belly).<\/p>\n<figure id=\"attachment_25533\" aria-describedby=\"caption-attachment-25533\" style=\"width: 500px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-25533 size-full\" src=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2009\/07\/MS-Mode.jpg\" sizes=\"auto, (max-width: 500px) 100vw, 500px\" srcset=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2009\/07\/MS-Mode.jpg 500w, https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2009\/07\/MS-Mode-300x188.jpg 300w\" alt=\"M mode echocardiogram in mitral stenosis \" width=\"500\" height=\"314\"><figcaption id=\"caption-attachment-25533\" class=\"wp-caption-text\">M mode echocardiogram in mitral stenosis<\/figcaption><\/figure>\n<p>M mode echocardiogram showing the paradoxical anterior motion of posterior mitral leaflet in diastole with reduced separation of the two leaflets. Anterior mitral leaflet has certain points marked in its movement: C, D,E and F. The EF slope is reduced in mitral stenosis \u2013 it becomes almost flat in severe mitral stenosis. CD is the closed position of the mitral leaflets in systole and DE is the opening excursion of the anterior mitral leaflet. A wave on M-Mode echocardiogram is absent in mitral stenosis.<\/p>\n<figure style=\"width: 500px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2010\/09\/M-mode-echocardiogram-in-mitral-stenosis1.jpeg\" alt=\"M-mode echocardiogram in severe mitral stenosis with flat EF slope\" width=\"500\" height=\"395\"><figcaption class=\"wp-caption-text\">M-mode echocardiogram in severe mitral stenosis with flat EF slope<\/figcaption><\/figure>\n<p>M-mode echocardiogram in mitral stenosis showing the flat EF slope and paradoxical motion of posterior mitral leaflet. Normally the anterior mitral leaflet shows an M shaped anterior movement and posterior mitral leaflet shows a smaller W shaped posterior movement pattern. The upper panel shows the doming of anterior mitral leaflet in diastole.<\/p>\n<figure id=\"attachment_25534\" aria-describedby=\"caption-attachment-25534\" style=\"width: 500px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-25534 size-full\" src=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2009\/07\/MS-PAH.jpg\" sizes=\"auto, (max-width: 500px) 100vw, 500px\" srcset=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2009\/07\/MS-PAH.jpg 500w, https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2009\/07\/MS-PAH-300x167.jpg 300w\" alt=\"Pulmonary valve M-Mode echocardiogram in mitral stenosis with pulmonary hypertension\" width=\"500\" height=\"278\"><figcaption id=\"caption-attachment-25534\" class=\"wp-caption-text\">Pulmonary valve M-Mode echocardiogram in mitral stenosis with pulmonary hypertension<\/figcaption><\/figure>\n<p>Mitral stenosis with pulmonary hypertension as evidenced by the flat EF slope of the pulmonary valve M mode echocardiogram and the shallow a wave, marked by the arrow. A mid systolic notch may also appear in severe pulmonary hypertension. When Doppler echo was not available, M mode of the pulmonary valve was an important tool to assess pulmonary hypertension.<\/p>\n<p><strong><span style=\"color: #0000ff;\">Assessment of Mitral Valve Area by Echo &#8211; 3D Planimetry, PHT, PISA<\/span><\/strong><\/p>\n<p><iframe loading=\"lazy\" title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/rnMVXzVO6yk\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><strong><span style=\"color: #0000ff;\">Wilkins Echocardiographic Score for Mitral Stenosis<\/span><\/strong><\/p>\n<p><iframe loading=\"lazy\" title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/7QwCKMe_9wA\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><strong><span style=\"color: #0000ff;\">Low Gradient Severe Mitral Stenosis<\/span><\/strong><\/p>\n<p><iframe loading=\"lazy\" title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/mkU5haCQ5WQ\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Assessment of mitral stenosis by echocardiography Right panel shows the parasternal long axis view. Doming of the anterior mitral leaflet is seen well and has the appearance of hockey stick. This appearance is classical of rheumatic mitral stenosis. Paradoxical movement of the posterior mitral leaflet is also visible. Normally posterior mitral leaflet moves posteriorly in [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":46493,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[2],"tags":[],"class_list":["post-46490","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cardiology"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Assessment of mitral stenosis by echocardiography - All About Cardiovascular System and Disorders<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/assessment-of-mitral-stenosis-by-echocardiography\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Assessment of mitral stenosis by echocardiography - All About Cardiovascular System and Disorders\" \/>\n<meta property=\"og:description\" content=\"Assessment of mitral stenosis by echocardiography Right panel shows the parasternal long axis view. Doming of the anterior mitral leaflet is seen well and has the appearance of hockey stick. This appearance is classical of rheumatic mitral stenosis. Paradoxical movement of the posterior mitral leaflet is also visible. Normally posterior mitral leaflet moves posteriorly in [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/johnsonfrancis.org\/professional\/assessment-of-mitral-stenosis-by-echocardiography\/\" \/>\n<meta property=\"og:site_name\" content=\"All About Cardiovascular System and Disorders\" \/>\n<meta property=\"article:published_time\" content=\"2021-06-27T00:08:31+00:00\" \/>\n<meta name=\"author\" content=\"Johnson Francis\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Johnson Francis\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/assessment-of-mitral-stenosis-by-echocardiography\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/assessment-of-mitral-stenosis-by-echocardiography\\\/\"},\"author\":{\"name\":\"Johnson Francis\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"headline\":\"Assessment of mitral stenosis by echocardiography\",\"datePublished\":\"2021-06-27T00:08:31+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/assessment-of-mitral-stenosis-by-echocardiography\\\/\"},\"wordCount\":746,\"publisher\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"image\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/assessment-of-mitral-stenosis-by-echocardiography\\\/#primaryimage\"},\"thumbnailUrl\":\"\",\"articleSection\":[\"Cardiology\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/assessment-of-mitral-stenosis-by-echocardiography\\\/\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/assessment-of-mitral-stenosis-by-echocardiography\\\/\",\"name\":\"Assessment of mitral stenosis by echocardiography - 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