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Diagnosis of mitral valve disease

Teaching Course on heart valves organised by the Hungarian Working Group on Echocardiography

  • Echocardiographic aspects of mitral valve anatomy, presented by R G Asbot (Budapest, HU)  
  • Echocardiographic evaluation of mitral stenosis, presented by R Faludi (Pecs, HU)  
  • Quantification and dynamic properties of mitral regurgitation, presented by A Varga (Szeged, HU)  
  • Assessment of mitral regurgitation. What can 3D add? presented by A Apor (Budapest, HU)  
  • Case presentation - Mitral stenosis, presented by Z Szelid (Budapest, HU)

The session was the first in a series of three sessions intended as a teaching course on mitral valve disease, organised by the Working Group on Echocardiography of the Hungarian Society of Cardiology.  This session touched mitral anatomy, basic questions on mitral stenosis and regurgitation and gave a glimpse at the perspectives of 3-dimensional echo along with the presentation of an interesting case. Later on the two other sessions discussed difficult clinical scenarios and the role of echocardiography in mitral interventions.

The first talk was on the echocardiographic aspects of mitral valve anatomy, presented by Dr Richard Asbot, Past President of the WG.  His overview included historic references on the connection between anatomy and function as emphasised by renowned Hungarian anatomists such as Prof Janos Szentagothai. Difficulties on describing and teaching the complex structure  were discussed. He concluded that precise knowledge of the anatomy is a prerequisite to giving an exact echocardiographic diagnosis, especially as it is expected in surgical cases.

The second presentation was given by Dr Reka Faludi on the echocardiographic evaluation of mitral stenosis.  Strengths and limitations of the methods measuring mitral gradients, valve area were discussed. If methodologically possible, direct valve area measurement should be preferred. Continuity equation and proxymal isovalocity surface area are hemodynamically reasonable calculations, in the everyday practice although relatively cumbersome methods.  She summarised that transthoracic echocardiography usually provides sufficient information for routine management of mitral stenosis and the assessment of valve morphology is important for the selection of the type of intervention.

The session’s next topic was presented by Prof Albert Varga about quantification and dynamic properties of mitral regurgitation.  He gave an excellent overview on the mechanisms of mitral regurgitation in organic, functional and ischemic mitral regurgitation.  Accuracy of the echocardiographic measurements and their prognostic impact was also discussed. The application of different quantitative and “semiquantitative” methods (vena contracta, CW Doppler spectrum, pulmonary vein systolic reverse flow, ERO, RF) is required. Jet area measurement is definitely not recommended.

Dr Astrid Apor masterly addressed the additional value of 3D in the assessment of mitral regurgitation.  She showed how a systematic characterisation of the mitral valve by 3D is feasible and underlined that 2D and 3D are complementary methods. Illustrative cases on Barlow’s, fibroelastic deficiency (FED) and mitral cleft were analysed. We could see high quality slides and videoclips presenting the 3D characterisation of PISA, ERO and VCA. The role of 3D in localising paravalvular leaks and post-repair insufficiency was also presented.

Finally an interesting case of a patient with stenotic mitral valve combined with giant left atrium was demonstrated by Dr Zsolt Szelid. Documentation of one year follow-up, including MRI emphasised the importance of collaboration between different imaging modalities.



The session covered the diagnosis of mitral valve diseases in a multi-method and multimodality approach. It gave a good basis for the forthcoming sessions of the mitral teaching course on the first day of the Congress.


Diagnosis of mitral valve disease

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.

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