Mitral valve lesions in patients with right ventricular pressure overload: analysis using realtime, two-dimensional echocardiography

Mitral valve lesions in patients with right ventricular pressure overload, such as pulmonary stenosis, tetralogy of Fallot, and pulmonary hypertension, were studied by real-time, two-dimensional echocardiography, and the following results were obtained. The abnormality observed in the mitral valve was a systolic dislocation of the anterior and posterior mitral leaflets at the coaptation zone. Mitral valve lesions were noted in 16 of 46 cases, i.e. nine of 11 with pulmonary hypertension (82%), four of 20 with tetralogy of Fallot (20%), and three of 15 with pulmonary stenosis (20%). The incidence was highest in patients with pulmonary hypertension. In eight of 16 cases with mitral valve lesions, mitral regurgitation was observed by either left ventriculography or two-dimensional Doppler echocardiography. Mitral valve lesions were always located at the posteromedial commissure of the anterior mitral leaflet. Considering the previous similar reports in secundum atrial septal defect, we attributed the cause of the mitral valve lesions to the same mechanism. No clear relation could be found between the left ventricular deformity index and the incidence of mitral valve lesion. Therefore, we could not conclude about the mode of production of mitral valve lesions occurring in the diseases with right ventricular pressure overload.