Morphological characteristics of the regurgitant rheumatic mitral valve.

Reparative surgery for valvular insufficiency is attempted frequently. The success of surgery depends partly on the underlying etiology. To establish the morphological characteristics of rheumatic mitral valve disease (insufficiency) (n = 12), mitral insufficiency due to infective endocarditis (n = 12), mitral insufficiency postinfarction (n = 6), rheumatic (predominant) mitral insufficiency postinfarction (n = 6), rheumatic (predominant) mitral stenosis (n = 12) and normal patients (n = 12) were examined retrospectively. In the groups of patients with mitral insufficiency< the mobility of the posterior leaflet tip (change in angle from the annular plane) was significantly less than normal 48 +/- 9 degrees only in the rheumatic group (12 +/- 7 degrees, P < 0.01). The posterior mitral leaflet tip had greater than normal mobility in the other mitral insufficiency groups: infective endocarditis 53 +/- 15 degrees (P = 0.35 versus normals), postinfarction 63 +/- 11 degrees (P = 0.02 versus normals), myxomatous 63 +/- 19 degrees (P = 0.03 versus normals). The mobility of the posterior mitral leaflet tip was also significantly less than normal in the rheumatic mitral stenosis group: 16 +/- 7 degrees, P < 0.01 versus normals. In the two rheumatic groups, diastolic doming of the anterior mitral leaflet was seen solely in mitral stenosis. In the predominant regurgitant group, the tip of the anterior mitral leaflet was much more mobile than in the stenosis group. Doming of the anterior mitral leaflet was absent from the predominant regurgitant group (2.1 +/- 0.9 cm, P < 0.001). The stenotic mitral valves domed 0.75 +/- 0.15 cm.(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiographic detection of tricuspid valve prolapse.

The echocardiographic findings in 12 patients with tricuspid valve prolapse are presented. Eight of these patients had associated mitral valve prolapse. Only one of the above patients had the characteristic physical signs of tricuspid incompetence. Two types of abnormality were noted on the echocardiogram of the tricuspid valve. In eight patients, the systolic segment of the tricuspid valve showed an initial horizontal motion followed by a posterior motion in midsystole. Four patients exhibited posterior motion of the tricuspid valve in early systole, which reached a maximum in midsystole, and this was followed by an anterior motion, thus producing a hammock-like configuration. We conclude that echocardiography is useful in the diagnosis of tricuspid valve prolapse. Since this condition may be associated with clinically significant tricuspid incompetence or bacterial endocarditis, its recognition is of clinical importance.