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Assessment of Mitral Valve Area from Long Axis and Apical 4-Chamber Echocardigraphic Views Correlation with Direct Intra-operative Measurements



Assessment of Mitral Valve Area from Long Axis and Apical 4-Chamber Echocardigraphic Views Correlation with Direct Intra-operative Measurements







The standard two-diminishional echocardographic (2-D echo) measurements of Mitral Valve Area (MVA) from the short axis is technically demanding; requires experience and expertise and may not be feasible in some patients. The maximum distance between anterior and posterior mitral leaflet tips as measured from the 2-D Long Axis and Apical 4-chamber views, the Mitral Tip Separation (MTS), has been reported to be valuable for measuring MVA in patients with rheumatic Mitral Stenosis (MS). The aim of this study was to evaluate the use of the simple measurements of maximal 2-D diastolic MTS in determination of MVA via its correlation with the directly measured MVA during open mitral valve surgery in patients with rheumatic MS and to evaluate the reproducibility and sensitivity of this technique. This study comprised 184 patients with rheumatic MS, who were evaluated and subjected to open mitral valve surgery at Cardiothoracic Department, Mansoura University Hospital, in the period from January 1996 to December 22. For every patient 2-D echo evaluation and estimations of MTS from Long Axis and Apical 4-chamber views, MVA from Short Axis and Doppler estimated MVA were performed at two different setting before surgery. During the open mitral valve surgery, direct measurements of MVA were done with the aid of Hegar dilator. The 2-D diastolic MTS were obtained clearly in all studied patients with minimal (or no) inter-observer variation. The diastolic MTS were obtained easily from the Long Axis views than the Apical 4-chamber views (96.74 vs. 77.17%, p<.5). There a good positive correlations between direct intra-operative measurements of MVA by aids of Hegar dilator and 2-D diastolic MTS (r = .9977, p<.1). A simple equation can be applied for estimation of MVA when 2-D diastolic MTS values is equal to or less than 1.2 cm as follow: MVA (cm2) = 1.25 MTS (cm). The maximum diastolic 2-D MTS as measured from the parasternal Long Axis and/or Apical 4-chamber views is simple; reliable; accurate; reproducible; sensitive and easily applied echocardiographic method for determination of MVA in patients with rheumatic MS.

Accession: 036483461

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