[Pulsed Doppler-echocardiographic study of mitral valve dysfunction]

67 patients (pts)--20 with intact cardiac valve function, 15 with pure mitral stenosis, 20 with both mitral valve insufficiency and stenosis, 12 pts with pure mitral incompetence - have been investigated by non-invasive pulsed Doppler-echocardiography (PDE) previous to invasive right and left heart catheterization. The following criteria for evaluation of the PDE registrations are adopted: 1) Time-related correlation of ECG and flow velocity. 2) Formal analysis of the flow-velocity tracings. 3) Turbulence formation. 4) Maximum duration of flow. In pure mitral insufficiency, systolic turbulence formation is detected within the left atrium, which is present according to the severity only locally or throughout the entire left atrium. We calculated a specificity for the diagnosis of mitral incompetence of 94% and a sensitivity of 78%. In mitral stenosis a severity-dependent ventricular inflow velocity is prevalent - with an insidious onset until a dome-like or saw-tooth-like profile. Grading for severity of mitral stenosis can be performed as follows: the time from onset to maximum flow velocity of the diastolic inflows is measured and related to the time period of the cardiac cycle. A specificity of PDE for mitral stenosis of 88% and a sensitivity of 91% have been found. PDE is also being applied for assessment of hemodynamic efficacy of prosthetic mitral-valve replacement. In the evaluation of mitral valve dysfunction, PDE as a non-invasive technique is of high specificity and sensitivity as compared with the hemodynamic results of invasive procedures.