Analyze This Image: Summer in an Academic Institute

Ronald H Wharton, MD


August 25, 2016


A lot of information can be inferred from the M-mode images that are usually acquired at the beginning of a study.

Figure 1

In the aortic M-mode (Fig 1), the aorta can be seen to be literally "bouncing up and down" through the cardiac cycle. This reflects the change in volume between the left atrium's end-diastolic and end-systolic volumes. That means that the stroke volume of the left atrium is "high," which is another way of stating that there is a large volume of blood passing through the mitral valve.

Figure 2

The M-mode through the left ventricle (Fig 2) similarly demonstrates a large difference between its end-diastolic and end-systolic dimension. This also suggests a large stroke volume.

Now, let's take a second look through the M-mode of the aortic valve (Fig 1). The ejection period is measured to be only 170 s; that is typically associated with a poor stroke volume through the left ventricular outflow tract. The leaflets of the aortic valve close more like a "hexagon" than a "rectangle"; ie, as systolic ensues, there is insufficient flow to keep the leaflets parallel.

Putting it all together, there is sufficient information available to suspect severe mitral regurgitation, which is exactly what is taking place (note the flail posterior mitral leaflet in the following images):

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Figure 3

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Figure 4

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