Two‐Dimensional echocardiographic evaluation of the severity of mitral stenosis with reference to the prediction for mitral valve commissurotomy or replacement

Thirty patients with mitral stenosis were classified into three grades of severity reflected by anterior mitral leaflet and subvalvular apparatus using two‐dimensional echocardiography in order to study the possibility of predicting the type of surgery indicated, and were evaluated pre‐ and postoperatively for systolic and diastolic volumes; left heart function using left ventricular posterior wall movement (LVPWVs max , LVPWVd max ) and posterior wall excursion (PWE) and newly devised left atrial empty volume ratio (LAEVR). The LVPWVs max was increased from 57±7 to 74±7 mm/s (p<0.001) in grade I, from 48±13 to 63±9 mm/s (p<0.02) in grade II, and from 44±6 to 64±7 mm/s (p<0.001) in grade III. The LVPWVd max showed an increase from 68±15 to 91 ± 15 mm/s (p<0.001) in grade I, from 57±17 to 86±18 mm/s (p<0.01) in grade II, and from 55±11 to 83±6 mm/s (p<0.01) in grade III. In the PWE, there was an improvement from 12.4±1.6 to 15.5±2.1 mm (p<0.01) in grade I; from 10.5±2.0 to 12.5 ± 1.5 mm (p<0.02) in grade II; and from 9.4±1.5 to 14.4 ± 1.5 mm (p<0.001) in grade III. In the LAEVR, there was also an improvement from 65 ± 12 to 39±21% (p<0.01) in grade I; from 53±13 to 51 ± 12% in grade II; and from 67±15 to 32±18% (p<0.001) in grade III. From these results, it may be concluded that even in cases with dome formation of the anterior mitral leaflet by two‐dimensional echocardiography, when a half or more of leaflet and subvalvular apparatus are thickened, it is difficult to obtain good valvular and left heart function by open mitral commissurotomy and suggests recommendation of mitral valve replacement in grade II and III cases.