Presentation
The patient has a history of pneumonia. He complained of coughing and dyspnoea. Heart rate is normal.
Patient Data
Thickened and calcified mitral valve leaflet tips with diastolic doming of the anterior mitral valve leaflet giving a "hockey stick" appearance and restricted motion of the posterior mitral valve leaflet. Colour 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 4-chamber view.
Mitral valve area by planimetry: 0.97cm2, transmitral mean pressure gradient: 25mmHg. Dilated left atrium, left atrial area:28cm2 , left atrial volume index (LAVI): 53mL/m2.
Mild tricuspid regurgitation (not shown) with mildly elevated pulmonary artery pressures, estimated systolic pulmonary artery pressures (sPAP): 46mmHg.
D-shaped left ventricle (flattening of the interventricular system) due to right ventricular overload. Normal bi-ventricular systolic function. Normal-sized left ventricle.
The heart margin on the right is partially obscured. There is bilateral extensive perihilar opacification in a batwing distribution. The pulmonary vasculature is normal. The costophrenic angles are clear. The bony cage is normal.
Conclusion:
Findings are suggestive of pulmonary oedema
Case Discussion
This is a case of severe mitral valve stenosis. The patient was scheduled for surgery.
Echocardiography is important in the diagnosis of mitral stenosis and the monitoring of patients after medicinal or surgical intervention.
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