Inter-scallop separations of the posterior leaflet of the mitral valve: an important cause of ‘pathological’ mitral regurgitation in rheumatic heart disease screening

Echo Research and Practice - 2018
L D Hunter1, Mark Monaghan2, Guy Lloyd3, Alfonso Pecoraro1, Anton Doubell1, Philip Herbst1
1Division of Cardiology, Tygerberg Hospital and University of Stellenbosch, Cape Town, South Africa
2Barts Heart Centre, St Bartholomew's Hospital, London, UK
3Kings College Hospital, London, UK

Tóm tắt

Summary The 2012 World Heart Federation (WHF) criteria for echocardiographic diagnosis of rheumatic heart disease (RHD) identify that the finding of ‘pathological’ mitral regurgitation (MR) in a screened individual increases the likelihood of detecting underlying RHD. Cases of isolated ‘pathological MR’ are thus identified as ‘borderline RHD’. A largescale echocardiographic screening program (Echo in Africa) in South Africa has identified that inter-scallop separations of the posterior mitral valve leaflet (PMVL) can give rise to ‘pathological’ MR. The authors propose that this entity in isolation should be identified and excluded from the WHF ‘borderline RHD’ category. In this case report, we present two examples of ‘pathological’ MR related to inter-scallop separation from the Echo in Africa image database. We further provide screening tips for the accurate identification of this entity.

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