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M mode echo cardiography and bi dimensional echo cardiography in 63 cases with rheumatic valvular heart disease surgical and anatomo pathologic correlations

M mode echo cardiography and bi dimensional echo cardiography in 63 cases with rheumatic valvular heart disease surgical and anatomo pathologic correlations

Archivos del Instituto de Cardiologia de Mexico 50(4): 451-460

Cases [63] were studied over 10 mo. Subgroup A consisted of 43 patients, with cross-sectional echocardiography before surgery. The intercommissural mitral diameter, mitral valve orifice area, systolic coadaptation of the mitral leaflets and localization of Ca and/or thrombi were studied. The correlation between the intercommissural diameter obtained with the bi-dimensional technique and that measured in surgery yielded an r = 0.92 in 36 cases. The correlation between the mitral orifice area estimated with the bi-dimensional echocardiography and that obtained in pathology yielded an r = 0.95 in 12 cases. Valvular regurgitation was diagnosed in 70% of those cases. In 21 cases, surgery confirmed the localization of Ca detected by 2-dimensional echocardiography. In 2 cases thrombi were discovered in the left atrium. The subgroup B consisted of 20 patients studied with M mode and bi-dimensional echocardiography before and after mitral commissurotomy. With the M Mode technique reduction of the size of the left atrium was demonstrated in 12 cases. In 4 cases, modification of diastolic movement of the posterior leaflet was shown. In nearly the entire subgroup, increases in the E-F slope of the C-E excursions were demonstrated. The mitral valve closure index (MVCI) increased in 17 cases. With the bi-dimensional technique the valvular orifice areas before and after commissurotomy were determined, and the percentage of their increases were compared with the increases of the E-F slope and the MVCI. No significant correlations were found. The advantages of the M mode and bi-dimensional echocardiographic techniques are subject to discussion in the study of rheumatic mitral valvulopathy.

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