Cross-sectional echocardiographic detection of rheumatic mitral regurgitation

Short-axis, cross-sectional echocardiograms of the mitral valve were performed in 20 consecutive patients with rheumatic mitral valve disease to determine if mitral regurgitation could be detected. In four patients, cross-sectional echocardiograms were technically inadequate. Of the 16 remaining patients, 8 had no significant mitral regurgitation on cineangiography, and 8 had significant regurgitation. Two independent observers reviewed videotapes of the cross-sectional echocardiograms without knowledge of the cineangtograms or clinical findings. In each case, the presence of significant mitral regurgitation was correctly predicted by viewing the cross-sectional echocardiograms. The thickened leaflets of the mitral orifice could easily be identified during both diastole and systole. Closure of the two leaflets was best observed early in systole before caudal movement of the anulus caused the orifice to move out of range of the ultrasonic beam. Complete closure of the leaflets was seen in patients without mitral regurgitation. Failure of closure of small areas of either the medial or lateral aspect of the valve was associated with insignificant mitral regurgitation. Failure of both sides to close or failure to close in the center of the valve indicated significant mitral regurgitation. Thus, it appears that significant mitral regurgitation in patients with rheumatic mitral valve disease can be detected by qualitative analysis of short-axis, cross-sectional echocardiograms.