Journal of Postgraduate Medicine
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CASE REPORT
 
 
Year : 1979  |  Volume : 25  |  Issue : 4  |  Page : 239-240  

Congenital mitral stenosis

Lilam S Shah, AS Vengsarkar 
 Department of Cardiology, K.E.M Hospital, Parel, Bombay 400012, India

Correspondence Address:
Lilam S Shah
Department of Cardiology, K.E.M Hospital, Parel, Bombay 400012
India

Abstract

Echocardiographic features of congenital mitral stenosis in a six year old female child is described. A significantly reduced ampli­tude of anterior mitral leaflet (8 mm.) in early diastole suggested a tight mitral stenosis with moderate degree of hypoplasia of the left ventricle. Post-operatively echocardiogram was repeated; it was compared with the pre-operative echocardiogram.



How to cite this article:
Shah LS, Vengsarkar A S. Congenital mitral stenosis.J Postgrad Med 1979;25:239-240


How to cite this URL:
Shah LS, Vengsarkar A S. Congenital mitral stenosis. J Postgrad Med [serial online] 1979 [cited 2020 Jun 4 ];25:239-240
Available from: http://www.jpgmonline.com/text.asp?1979/25/4/239/42228


Full Text

 Introduction



Echocardiography has been found t, be very much useful in diagnosing con genital malformations affecting the mitral valve, primarily or secondarily. [1],[5],[6] These malformations include mitral atresia, congenital mitral stenosis, hypoplastic left heart syndrome and cor triatriatum.

 Case report



A six year old female child presented to us with the complaints suggestive of repeated attacks of respiratory tract infection, effort intolerance (dyspnoea class II) and precordial pulsations since early childhood. There was no history of rheumatic joint pains. Clinical fea­tures were suggestive of mitral stenosis of severe degree. Echocardiographic studies re­vealed abnormal anterior motion of the poste­rior mitral leaflet (PML) during the diastole. EF slope was 7 mm/sec. Both the leaflets were thin. Early diastolic opening amplitude (DE) was 8 mm (See [Figure 1] on page 238B), suggesting tight mitral stenosis with moderate degree of hypoplasia of the left ventricle. Left atrial size was 2, cm. There was no evidence of mitral valve calcification.

In view of the early onset of symptoms and clinical and echocardiographic findings, a pos­sibility of congenital mitral stenosis was thought of. The child was subjected to mitral valve commissurotomy. Post-operative echo (See [Figure 2] on page 238B) showed improvement in diastolic slope (EF 40 mm/sec.). Posterior mitral leaflet showed diastolic posterior motion. Opening ampliude (DE) was 10 mm.

 Discussion



A preliminary report under the use of reflected ultrasound for studying congeni­tal heart malformation in children has been published by Lundstrom et al [4] The same authors have published echocardio­graphic diagnosis of mitral atresia, con­genital mitral stenosis, hypoplasia of the left ventricle and cor triatriatum. [2],[3] Magnitude of the opening amplitude can help to decide the severity of mitral stenosis. Small opening amplitude of the anterior mitral leaflet in early diastole suggests tight mitral stenosis, combined with moderate or severe degree of hypo­plasia of the left ventricle, or moderate mitral stenosis combined with severe de­gree of hypoplasia of the left ventricle. The other group is characterized by less reduced opening amplitude of the ante­rior mitral leaflet. This suggests mild mitral stenosis with moderate degree of hypoplasia of the left ventricle.

According to this classification, our case belongs to the first group where opening amplitude of anterior mitral lea­flet was reduced to 8 mm. suggesting tight mitral stenosis with moderate degree of left ventricular hypoplasia. At surgery, the patient was found to have a congeni­tal tight mitral stenosis.

Some other features reported in litera­ture were not present in this case.

References

1Kronzon, I. and Mehta, S. S.: Giant left atrium. Chest, 65: 677-679, 1974.
2Lundstrom, N. R.: Echocardiography in the diagnosis of results of mitral valvo­tomy. Circulation, 46: 44-54, 1972.
3Lundstrom, N. R.: Ultrasound cardio­graphic studies of the mitral valve lesion in young infants with mitral atresia, mitral stenosis, hypoplasia of left ven­tricle and cor triatriatum. Circulation, 45: 324-334, 1972.
4Lundstroma, N. R. and Edler, I.: Ultra­sound cardiography in infants and child­ren. Acta Paediat. Scandinav., 60: 117­128, 1971.
5Meyer, R. A. and Kaplan, S.: Echocardio­graphy in the diagnosis of hypoplasia of the left or right ventricle in the neonate. Circulation, 46: 55-64, 1972.
6Moss, A. J., Gussoni, C. C. and Isabel­Jones, J.: Echocardiography in congeni­tal heart disease. Western J. Med., M­102-121, 1976

 
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