[2-dimensional echocardiography of congenital obstruction of left ventricle inflow. Apropos of 25 cases].

Twenty-five cases of left ventricular inflow obstruction in children aged 4 months to 11 years were investigated by two-dimensional echocardiography and cineangiography. The results of 2D echo were compared with the operative appearances in 15 cases and the pathological findings in three cases. This series included 5 cases of cor triatrium and 20 of congenital mitral stenosis, 3 of which were associated with a supramitral ring. Abnormalities of the mitral papillary muscles were the main cause of congenital mitral stenosis in this series (12 cases); there were 6 cases of single papillary muscle and 6 cases with two closely situated or fused papillary muscles. These abnormalities of the mitral papillary muscles were demonstrated on the transverse left ventricular views obtained from the parasternal or subcostal regions. All the papillary muscle abnormalities diagnosed by 2D echo were confirmed at autopsy or surgery. Cases of mitral stenosis due to short and thickened chordae were demonstrated on parasternal long axis views. Hypoplasia of the mitral ring was visualised on long axis or apical views. The supramitral ring was demonstrated on the parasternal long axis or apical four chamber views, as an abnormal echo situated just above the mitral valve in the left atrium. All three cases in this series were correctly diagnosed by 2D echocardiography. Nineteen of the 20 congenital mitral stenoses were associated with other cardiac malformations (14 coarctations of the aorta, 9 aortic stenoses, 4 ventricular septal defects) which were also detected by 2D echocardiography.