ECHOCARDIOGRAPHIC ASSESSMENT OF MITRAL-STENOSIS AND ITS ASSOCIATED VALVULAR LESIONS IN 205 PATIENTS AND LACK OF ASSOCIATION WITH MITRAL-VALVE PROLAPSE

To date, the relation between mitral stenosis (MS) and other associate d cardiac valvular lesions has been reported by angiography and surgic al pathologic study in patients with more advanced disease but has not been studied systematically by two-dimensional echocardiography and D oppler color flow mapping in a large referral population with a broade r spectrum of severity. In addition, prior reports have suggested that up to 40% of patients with MS have mitral valve prolapse (MVP); howev er, because of recent developments in two-dimensional echocardiographi c imaging and the definition of MVP, this association must now be reco nsidered. The purpose of this study was to explore the association of other valvular lesions with MS and their relation to its severity and in particular to test whether MS is in fact associated with MVP with t he frequency reported previously. We reviewed the studies of 205 conse cutive patients (aged 61 +/- 14 years; range 26 to 87 years) with MS w ho were studied from 1992 to 1994 by two-dimensional echocardiography and Doppler color how mapping to assess valvular stenosis, regurgitati on, and MVP in patients with a range of severity of MS (28% mild, 34% moderate, and 38% severe MS based on mitral valve area). MS was associ ated with at least mild mitral regurgitation in 78% of patients (160/2 05), and pure MS was correspondingly uncommon (22%). There was an inve rse relationship between the severity of MS and the degree of mitral r egurgitation (p < 0.001). MS was frequently associated (54% of patient s) with significant lesions of other valves, including aortic stenosis (17%), at least moderate aortic regurgitation (8%) and tricuspid regu rgitation (38%), and tricuspid stenosis (4%). Tricuspid stenosis was a ssociated with more severe MS (p < 0.01), and tricuspid regurgitation was more common in patients with mixed MS and regurgitation than in th ose with pure stenosis (60% versus 26% for at least moderate tricuspid regurgitation; p < 0.001). Mitral valve prolapse was present in only one patient (0.5%). Superior systolic bulging of the midportion of the anterior mitral leaflet toward the left atrium (but not superior to t he annular hinge points) was seen in 22 patients (11%). Patients with such superior bulging had significantly lower mitral valve scores but a similar degree of mitral regurgitation compared with those without b ulging. The majority of patients with MS (78%) have associated mitral regurgitation and significant lesions of the other cardiac valves (54% ). The frequency of true MVP associated with chronic MS is much lower than reported previously. This may provide insight into the underlying pathophysiologic process, tending to shorten the chordae tendineae an d leaflets to produce stenosis rather than elongate them to produce pr olapse.