Search

One hundred forty nine subjects have their echocardiography recorded by Echoview apparatus, Picker firm. The echocardiographic parameters found in 72 patients in pure or almost pure mitral stenosis were confronted to those of 77 healthy subjects. The high sensitivity of the echocardiographic method is stressed upon in the differentiation of mitral stenosis. The most important echocardiographic criterion of mitral stenosis is the slowed down speed of the early diastolic movement, EF of the anterior mitral cusp and the shifting of the posterior mitral cusp forward from the line, passing through the point of the mitral closing. Confirmed diagnosis of mitral stenosis could only be obtained by the combination of those two echocardiographic changes. Echocardiographic significance is stressed in the establishment of the thickness of the two mitral cusps, increased number of component echolines and amplitude decrease in anterior mitral cusp opening in the assessment of the presence of mitral fibrosclerosis and calcinosis.

The diagnostic sensitivity, specificity and predicting accuracy of the various alterations, established by one-dimensional echocardiography (M-EchoC) were determined in 23 patients with rupture of mitral chordae. The diagnosis of mitral insufficiency, resulting from chordal rupture was confirmed at operation, with angiocardiography and/or bi-dimensional echocardiography. Almost all MEchoC alterations were with a relatively low sensitivity (10-50%), high specificity (60-100%) and moderately high predicting accuracy (50-80%). Of more essential diagnostic significance--moderate sensitivity and high specificity with high predictive accuracy, are the following alterations: systolic fibrillation of mitral valve, diastolic fibrillation of mitral valvular cusps, paradoxical (chaotic) movement of posterior mitral cusp during diastole. Very little sensitivity (10%) but with high specificity (100%) was established in pathological systolic echoes in the cavity of left auricle. In the majority of the cases, the rupture of mitral chordae induced grave mitral regurgitation, conditioning the various stages of cardiac insufficiency. Relatively rare is the light to moderately grave mitral regurgitation with stable hemodynamics and preserved functional capacity.

In 36 patients with pure mitral stenosis verified during catheterization and operation the results of echocardiography were compared with the operative findings. The changes in the mitral echogram and the degree of valve calcification before commissurotomy were studied. The hemodynamic changes in pulmonary circulation were approximately appraised by determining the degree of delay of the EF interval on the echogram of the anterior cusp of the mitral valve. Significant conformity between the dimished rate of diastolic movement of the anterior mitral cusp and the degree of mitral stenosis was established. The importance of the advancement of the posterior mitral cusp to the front of the horizontal line passing through point C of mitral valve closure in the appraisal of the degree of its stenosis is underscored.

In 23 patients with mitral valve chordae rupture, the diagnostic sensitivity, specificity and predictive accuracy of various changes found by one-dimensional echocardiography (M-echo) were determined. Nearly all M-echo changes have a relatively low sensitivity (10-50%), high specificity (80-100%) and moderate predictive accuracy (30-80%). Greater diagnostic value--moderate sensitivity, high specificity and greater predictive accuracy--is shown by the following changes: systolic mitral valve flutter, diastolic mitral leaflets flutter, paradoxical (chaotic) movement of the posterior mitral leaflet in diastole. Of very low sensitivity (10%) but high specificity (100%) are pathological systolic echo-signals in the left atrial cavity.