A 40 year old female presented with dyspnea. Spot the findings on the basis of echocardiography clips shown, answer is given after one minute with explanation of findings.

Case 87 : FINDINGS & DIAGNOSIS:
Para-sternal long axis view is showing dilated LA and thickened mitral valve leaflets with characteristic hockey stick appearance of anterior leaflet which is typical of rheumatic mitral stenosis (MS). This appearance is due to thickening and diastolic doming of leaflet. Apical 4 chamber and three chamber views with color Doppler are shown showing mild mitral regurgitation. Continuous Wave Doppler via Mitral valve is showing mean grading of 15 mmHG suggestive of Severe Mitral Stenosis. There is also severe TR (with estimated RVSP of 52mmHg + RAP)

Assessment of Rheumatic Mitral Stenosis should also include morphological assessment of MV leaflets and sub-valvular apparatus. This assessment helps in identification of the underlying etiology of MS (organic [mainly rheumatic], or congenital). The main features can be summarized as follows:
1. In the parasternal long-axis view, the main diagnostic feature in rheumatic MS is the diastolic doming or hockey-stick shape of the anterior mitral leaflet. This doming is due to the reduced mobility of the valve tips compared to the base of the leaflets. The extent of doming of the anterior leaflet can be assessed subjectively or objectively by the Reid grading system. The posterior mitral leaflet motion is usually restricted.
2. In the parasternal short-axis view of the MV, the leaflet thickening and fusion of commissures and chordae.
3. Modified long-axis and 4‑chamber views are used to visualise the chordae and their abnormalities properly.
4. Consequences of MS on other cardiac chambers such as left atrial dilatation, tricuspid regurgitation and also right ventricular function should be evaluated by echocardiography.

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This Case highlights:
01:06 Rheumatic Mitral Stenosis
02:00 Severe Mitral Valve Stenosis
Importance of Echocardiography in the assessment of rheumatic Heart Disease.
Hockey Stick appearance on echocardiography.
#echocardiography #cardiology #echo #echocardiogram #2decho #Echobasics #anatomy #medical #heart #rheumatic #rhd #mitralstenosis #mitralregurgitation #mitral

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