Case #1

Case #2

Case #3

Case #4

Age

27

17

28

22

Gender

Male

Male

Male

Female

Clinical presentation

Duration of symptoms

2 yrs

1 yr

1yr

2 yrs

Dyspnea

Class II

Class II

Class II

Class III

h/o rheumatic fever in past

12 yrs back

--

15 yrs back

11 yrs back

Rhythm

Regular

Regular

Regular

Regular

Murmur

MDM grade IV/IV at apex, no systolic murmur

MDM grade IV/IV at apex, no systolic murmur

MDM grade II/IV at apex, no systolic murmur

MDM grade IV/IV at apex, no systolic murmur

OS

--

--

+

+

ECG

NSR, LAE

NSR, LAE

NSR, LAE

NSR, LAE

ECHO

Dilated chambers

LA, RA, RV; LA size―63 × 59 mm

LA, RA, RV;

LA size―62 × 53 mm

Only LA ; LA size―59 × 49 mm

Only LA ; LA size―55 × 44 mm

Mitral valve

Double orifice, both of near equal size ? spectacle appearance

Unequal orifice, anterolateral larger

Unequal orifice, posteromedial smaller

Unequal orifice

(posteromedial larger)

Mitral valve area (MVA) cm2

Planimerty―0.67 each

Posteromedial―0.64 anterolateral―0.45, total―1.09

Posteromedial―0.37 anterolateral―0.57, total―0.94

posteromedial―0.8

anterolateral―0.36

Mean trans-mitral gradient (mm Hg)

16

12

11

11

MR

Trivial

No

Grade I, from posteromedial commissure

No

PASP (TR jet)

mmHg

65

60

70

60