This is a still-frame of a two-dimensional parasternal long axis view that clearly shows a markedly dilated left atrium, along with a dilated left ventricle. The thickened anterior and posterior mitral valve leaflets that are typical of rheumatic disease, and two aortic valve leaflets are well seen.
In the real-time study that follows, note the excursion of the posterior mitral leaflet is reduced, and left ventricular systolic function appears preserved.
However, in patients with chronic mitral regurgitation, one would expect an augmentation of systolic function. Note also that the patient is in atrial fibrillation.
Color flow Doppler modified PLAX
This is a still-frame of a color flow Doppler image from a modified parasternal long axis view. The left ventricle and the enlarged left atrium can be seen. The turquoise mosaic color pattern represents the turbulent systolic blood flow of mitral regurgitation from the left ventricle into the left atrium. In the real-time study that follows, note the marked turbulent flow along the inferior left atrial wall.
Parasternal short axis view
This is a still-frame of the parasternal short axis view recorded at the level of the aortic valve. It clearly shows the markedly dilated left atrium and a prominent left atrial appendage. The left atrium contains a mural thrombus along the lateral wall. In the real-time study that follows, note that the interatrial septum bulges into towards the right atrium during ventricular systole, a finding consistent with significant mitral regurgitation.
Apical 4-chamber view
This is a still-frame of the apical 4-chamber view showing the mitral valve. Note that the left atrium is bigger than the left ventricle and that a mural thrombus is seen along the left atrial wall. In the real-time study that follows, note that the movement of the thickened anterior mitral valve leaflet is relatively unrestricted, while the movement of the thickened posterior leaflet is more restricted. These findings are consistent with a rheumatic etiology.