Presentation
Known hypertensive presents with dyspnea, cough and general body weakness. Sinus bradycardia, heart rate 47 bpm.
Patient Data
Thickened and calcified mitral valve leaflet tips with diastolic doming of the anterior mitral valve leaflet and restricted motion of the posterior mitral valve leaflet. Color Doppler of the mitral valve in diastole shows a flow acceleration towards the stenotic orifice seen as the red jet inside the left ventricle on the apical 5-chamber view. Mitral annular calcification is also noted.
Mild mitral regurgitation. Bi-atrial dilatation.
Mitral valve area by planimetry: 0.71cm2, transmitral mean pressure gradient: 10mmHg, pressure half time: 295ms. Mitral leaflet separation index: 0.6cm.
Severe tricuspid regurgitation with elevated pulmonary artery pressures, estimated sPAP>60mmHg.
Good bi-ventricular systolic function. Normal-sized left ventricle and right ventricle.
Case Discussion
Degenerative mitral stenosis is characterized by decreased mitral valve orifice area, increased transmitral pressure gradient due to chronic non-inflammatory degeneration and subsequent calcifications of the fibrous mitral annulus and/or mitral valve leaflets and it predominantly affects elderly individuals.
The several risk factors which support calcific degeneration include; aging, hypertension, diabetes, atherosclerosis, and kidney disease.
This is a case of severe mitral stenosis in a 50-year-old female with hypertension. She was scheduled for mitral valve replacement.