ABSTRACT
In the West, most patients with rheumatic mitral disease are elderly and have calcified and thickened valves with left atrial enlargement and atrial fibrillation. While the incidence of rheumatic mitral valve disease is declining in western countries, it remains a major health problem in some developing nations. In developing countries, patients are younger and have thin and pliable valves with a characteristic domed appearance without obvious subvalvar involvement. The nature of commissural fusion may be examined an important point in patients considered for conservative surgery or mitral balloon valvotomy. The mitral orifice area is readily obtained by interrogation using continuous-wave Doppler of the mitral valve from the apex, and allows measurement of the orifice using the pressure half-time method. The correlation between short-axis parasternal measurements of the mitral orifice area by planimetry and pressure half-time Doppler estimations is good, but the latter is more reliable in the presence of calcification and previous surgery.
