title: Echocardiographic Assessment of Degenerative Mitral Stenosis: A Diagnostic Challenge of an Emerging Cardiac Disease.
abstract: Degenerative mitral stenosis (DMS) is characterized by decreased mitral valve (MV) orifice area and increased transmitral pressure gradient due to chronic noninflammatory degeneration and subsequent calcification of the fibrous mitral annulus and the MV leaflets. The "true" prevalence of DMS in the general population is unknown. DMS predominantly affects elderly individuals, many of whom have multiple other comorbidities. Transcatheter MV replacement techniques, although their long-term outcomes are yet to be tested, have been gaining popularity and may emerge as more effective and relatively safer treatment option for patients with DMS. Echocardiography is the primary imaging modality for evaluation of DMS and related hemodynamic abnormalities such as increased transmitral pressure gradient and pulmonary arterial pressure. Classic echocardiographic techniques used for evaluation of mitral stenosis (pressure half time, proximal isovelocity surface area, continuity equation, and MV area planimetry) lack validation for DMS. Direct planimetry with 3-dimensional echocardiography and color flow Doppler is a reasonable technique for determining MV area in DMS. Cardiac computed tomography is an essential tool for planning potential interventions or surgeries for DMS. This article reviews the current concepts on mitral annular calcification and its role in DMS. We then discuss the epidemiology, natural history, differential diagnosis, mechanisms, and echocardiographic assessment of DMS.
authors.forename: Ahmet Afşşin
authors.initials: AA
authors.lastname: Oktay
authors.forename: Yvonne E
authors.initials: YE
authors.lastname: Gilliland
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Lavie
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Ramee
authors.forename: Patrick E
authors.initials: PE
authors.lastname: Parrino
authors.forename: Michael
authors.initials: M
authors.lastname: Bates
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Shah
authors.forename: Michael E
authors.initials: ME
authors.lastname: Cash
authors.forename: Homeyar
authors.initials: H
authors.lastname: Dinshaw
authors.forename: Salima
authors.initials: S
authors.lastname: Qamruddin
mesh_terms: D002114:Calcinosis / Q000000981:diagnostic imaging / Q000601:surgery; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D011832:Radiation Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D011878:Radiotherapy / Q000009:adverse effects; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed