Rheumatic Mitral Valve Disease

  • Teerapat YingchoncharoenEmail author


A 21-year-old Caucasian college student was referred to our institution for management of severe mitral stenosis. His past medical history was significant for a history of acute rheumatic fever at age 12. He was then followed by his local cardiologist; yearly echocardiography found normal left ventricular (LV) ejection fraction without significant valvular abnormalities. He did not see a cardiologist for a few years, and his last echocardiogram was 5 years ago. He was doing well until 2 months ago, when he felt shortness of breath while playing volleyball. He went to see his cardiologist and was found to have moderate to severe mitral stenosis.


Rheumatic valve disease Balloon valvuloplasty 

Supplementary material

Video 5.1

Transesophageal echocardiography (TEE) showed thickened mitral valve with restricted opening (AVI 2662 kb)

Video 5.2

Color flow imaging showed diastolic flow acceleration across the mitral valve during diastole (AVI 2135 kb)

Video 5.3

Three-dimensional imaging of the ventricular side of the mitral valve showed limited opening of the valve (AVI 2636 kb)

Video 5.4

X-plane imaging showing orthogonal imaging of the interatrial septum at the puncture site at the time of the percutaneous balloon mitral commissurotomy (PBMC) (AVI 2450 kb)

310450_1_En_5_MOESM5_ESM.avi (2.1 mb)
Video 5.5 The Inoue balloon inflated at the mitral valve (AVI 2191 kb)
Video 5.6

Post PBMC. Improved mitral valve opening (AVI 2952 kb)

Video 5.7

Post PBMC. Mitral valve area is increased (AVI 3022 kb)

Video 5.8

Post PBMC. Mild mitral regurgitation (AVI 1995 kb)

Video 5.9

Transthoracic echocardiography (TTE), parasternal long-axis, showed severe mitral calcification with restricted opening. The aortic valve was also calcified, with restricted excursion, and the right ventricle is enlarged (AVI 3307 kb)

Video 5.10

TTE, parasternal with color Doppler flow imaging, showed mitral regurgitation (AVI 1480 kb)

Video 5.11

TTE (four-chamber view) demonstrating severe calcification of the mitral valve resulting in severe pulmonary hypertension (estimated right ventricular systolic pressure of 91 mmHg) and severe right ventricular dilatation with resultant failure of tricuspid valve leaflet coaptation. Severe atrial enlargement and a pericardial effusion are noted (AVI 3907 kb)

Video 5.12

Color Doppler imaging across the tricuspid valve confirms the presence of associated severe tricuspid regurgitation (AVI 2575 kb)

Video 5.13

TTE (five-chamber view) showing calcified and thickened aortic valve with restricted opening (AVI 3033 kb)

Video 5.14

TTE (five-chamber view) with color Doppler flow showing mild aortic insufficiency (AVI 2135 kb)

Video 5.15

TEE (four-chamber view) confirms severely calcified mitral valve with malcoapted tricuspid valve (AVI 5443 kb)

Video 5.16

TEE (four-chamber view) with color Doppler flow imaging confirms moderate mitral regurgitation and enlarged right-sided cardiac chambers (AVI 2091 kb)

Video 5.17

TTE (parasternal long-axis view) showed a thickened mitral valve with diastolic doming and restricted opening, findings consistent with rheumatic mitral valve disease (AVI 3378 kb)

Video 5.18

TTE (parasternal long-axis view) with color Doppler imaging showed severe mitral regurgitation (AVI 4245 kb)

Video 5.19

TTE (four-chamber view) showed dilated left atrium with severe mitral valve thickening with restricted opening and closure (AVI 3318 kb)

Video 5.20

TTE (four-chamber view) zoomed at mitral valve and left atrium showed severe mitral regurgitation (AVI 3582 kb)

Video 5.21

TEE (four-chamber view) showed malcoapted mitral valve due to severe restriction of the leaflets (AVI 3196 kb)

Video 5.22

TEE (long-axis view) again showed malcoapted mitral valve due to severe restriction of the leaflets (AVI 3215 kb)


  1. 1.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin 3rd JP, Guyton RA, et al. ACC/AHA Task Force Members. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:e521–643.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Department of Cardiovascular MedicineCleveland ClinicClevelandUSA

Personalised recommendations