Abnormal mitral valve motion as demonstrated by the ultrasound technique in apparent pure mitral insufficiency

Mitral valve motion was studied by the reflected ultrasound technique in twentyfour patients with clinically pure mitral valve diastolic descent rate was normal or faster than normal (82 ± 12 to 200 ± 22 mm. per second) with normal amplitude of excursion (20 to 37 mm.). Eleven patients exhibited slower than normal diastolic descent rates (18 to 56 mm. per second). Six of seven patients with extensive valvular calcification exhibited amplitudes of excursion less than 18 mm. Seven of the eleven patients were found to have minimal to mild mitral stenosis at surgery or catheterization with ultrasound slopes of 18 to 49 mm. per second, and four had no evidence of mitral stenosis. These findings indicate that an abnormally slow ultrasound diastolic slope may be due not only to mitral stenosis, but also to structural alteration of the mitral valve apparatus which produce pure mitral regurgitation or high grade mitral regurgitation with minimal or mild mitral stenosis. Diminished amplitude of excursion is related to increasing calcification regardless of whether the lesion is regurgitation or stenosis. It would, therefore, appear that correct interpretation of an abnormally slow ultrasound diastolic slope will depend upon a correlation with other clinical and technical findings.