Pulsed doppler echocardiographic study of mitral stenosis.

SUMMARYThe value of pulsed Doppler echocardiography in the assessment of mitral stenosis was studied in a consecutive series of 175 patients before right- and left-heart catheterization. All Doppler recordings were interpreted independently by two observers. Twenty patients had repeat studies to demonstrate the reproducibility of the method. Adequate recordings were obtained in 156 patients. A normal flow pattern was observed in all 41 patients in sinus rhythm without a mitral valve gradient but in none of the 51 patients in sinus rhythm with a mitral gradient. In atrial fibrillation the normal pattern was identified in all three patients with no mitral gradient but in none of the 61 with a gradient. Three patterns of mitral valve flow could be distinguished that corresponded to mild, moderate and severe stenosis. The mitral valve gradient in the 36 patients with pattern I was 6.1 ± 1.7 mm Hg (SD) (range 3–10 mm Hg); in 54 patients with pattern II it was 12.0 ± 2.5 mm Hg (range 8–18 mm Hg) (p < 0.001 vs I); in 22 patients with pattern III it was 22.0 ± 2.6 mm Hg (range 18–27 mm Hg) (p < 0.001 vs II). Overlap was observed in only four patients, all of whom had a gradient between 8–10 mm Hg. Mitral valve area was 2.14 ± 0.58 cm2 in pattern I, 1.17 ± 0.33 cm2 in pattern II and 0.67 ± 0.26 cm2 in pattern III (p < 0.001 between all groups). The presence of associated mitral regurgitation in 39 patients and aortic valve disease in 32 patients did not affect the Doppler assessment of mitral stenosis. Thus, pulsed Doppler echocardiography can accurately detect the presence of mitral stenosis and assess its severity.