An Appraisal of Mitral Valve Echocardiograms Mimicking Mitral Stenosis in Conditions with Right Ventricular Pressure Overload

Of seven patients with pulmonary hypertension, two had marked and one had moderate retardation of the echocardiographic anterior mitral valve leaflet closing motion, suggestive of mitral stenosis. In each patient, however, mitral stenosis was excluded by hemodynamic or anatomic criteria. The reason for the abnormal mitral valve motion was considered to be a reduced rate of left ventricular diastolic filling. In the group of seven patients it was noted that the ratio of ventricular filling pressures (RVedP/LVedP) was inversely correlated with the anterior mitral valve leaflet closing slope. This observation supports the hypothesis that left ventricular diastolic filling may be secondarily altered by right ventricular overload, and that this impairment of left ventricular filling may result in alteration of the anterior mitral valve leaflet echogram mimicking mitral stenosis.