Take a Guess - Indian Hockey

We are going to start off today's post a little differently. Today, we want you to just look at the first two images and try to guess what this post is all about.

Do you know what these images have to do with echocardiography?

A little clue:
Here is a hint: the top image shows the Taj Mahal in Agra, India. A mausoleum built by Shah Jahan for his beloved wife Mumtaz Mahal. It´s beauty is unmatched and now counts amongst the Seven Wonders of the World.The image below the Taj Mahal shows a hockey stick. A strange combination indeed, but it symbolizes a pathology which resembles a hockey stick and at the same time is very common in India.

And the answer is:
The disease we are focusing on is rheumatic mitral stenosis. As you can see in the echo below the hallmark of mitral stenosis is doming of the anterior leaflet. During diastole the leaflet has the shape of a “hockey stick”. (click on the images for video)

Mitral stenosis with doming of the anterior leaflet and thickening of the leaflet tips.

While the prevalence of mitral stenosis in most western countries is negligibly low, it is quite high in many Asian countries like India where as many as 55 per 100,000 individuals have rheumatic heart disease. This is mainly related to the fact that antibiotic treatment of streptococcal infection to prevent rheumatic heart diseases is less frequently performed in these countries.

In the west..
But there are some other differences in the way mitral stenosis presents in western countries compared to such countries as India.

Patients in western countries are in general older and the valves are thus often more calcified and “rigid”. Here are some examples of such patients:

Mitral stenosis in an elderly women. Note that the valve is heavily calcified.

3 chamber views of two different patients. Top: a calcified mitral valve.
Note that there is no “hockey stick” appearance of the anterior leaflet
because the mid and basal segments of the mitral valves are stiff.
Bottom: pliable anterior leaflet with hockey stick appearance.

Why is calcified mitral stenosis sometimes a problem? Because, such patients are no candidates for mitral valve valvuloplasty a catheter procedure in which the mitral valve is dilated with the help of a balloon catheter.

A few words from a true expert – Satish Govind
The burden of mitral stenosis in countries like India is immense. On the other side such countries also have extensive experience in the diagnosis, treatment and management of such patients. We recently had the chance to talk to Dr. Satish Govind of Bangalore who is one of the experts in the field. We don't want to keep his wisdom to ourselves and want to share it with you. Here is our interview with Satish!

If you want to learn even more about echo of the mitral valve, visit us at www.123sonography.com! We are here to help you reach your full potential!