[Two-dimensional echocardiography and mitral valve involvement].

Two-dimensional echocardiography has been a decisive advance in the investigation of rheumatic valvular disease. In mitral stenosis, short axis views enable a quantitative evaluation of mitral surface area by planimetry. Long axis views contain additional important information on the state of the subvalvular apparatus and on the possible presence of left atrial thrombosis. The quantitative assessment of regurgitant flow in mitral incompetence is difficult and can only be approximative. On the other hand, the mechanism of mitral incompetence may be clearly demonstrated in: - mitral valve prolapse with the characteristic bowing of the posterior leaflet; - rheumatic mitral incompetence with the abnormal valvular thickening showing the post-rheumatic retractile fibrosis; - ruptured chordae with eversion of the tip of one of the values in the left atrium; - infective endocarditis with ruptured chordae and vegetations; - cogenital mitral incompetence where the superiority of 2D echo over M mode is most marked, the apical incidences demonstrating the high VSD, ostium primum defect and cleft mitral valve. The limitations of the method are also discussed.