[Segmental analysis of the movement of the posterior mitral valve in mitral stenosis]. / Análisis segmentario del movimiento de la valva posterior de la mitral en la estenosis mitral.

We have analyzed independently, both, early diastolic and end diastolic (A wave) movements of the posterior mitral leaflet in 302 cases of mitral stenosis with sinus rhythm, as well as in a control group of 100 subjects without mitral stenosis. Studied patients were separated into two groups: 275 that were not treated surgically, and 27 studied after mitral commisurotomy. We described 4 patterns of posterior mitral leaflet early diastolic movement, and 3 patterns of A wave motion. Only those patterns that showed anterior drift of the studied segment of the posterior mitral leaflet, were considered diagnostic of mitral stenosis. The sensitivity found was 49% for the anterior early diastolic movement; 89,5% for the anterior A wave, and 95,3% for both signs considered together. The specificity was 99% for anterior A wave, with a predictive value of 99,6%. When surgical and non surgical groups were compared, the absence of anterior drift in early diastole in the former group, showed to have statistical significance when the Chi square test was employed, while A wave pattern (anterior drift) did not show any difference between both groups. It is concluded that the most sensitive and specific sign for M-mode echocardiagraphic diagnosis of mitral stenosis in patients with sinus rhythm is the anterior drift of posterior mitral leaflet's A wave.