The Correlation Between Mitral Valve Area (MVA) Assessed Using Planimetry, Vena Contracta Width (VCW) and Effective Regurgitant Orifice Area (EROA) Mitral Valve on Right Ventricular Longitudinal Strain (RVLS) in Mixed Mitral Valve Disease due to Rheumatic

Background: Rheumatic heart disease (RHD) is a sequelae of acute rheumatic fever which presents a significant health burden. A total 12.9% of RHD cases are multivalvular lesions, including mixed mitral valve disease. The complexity of mixed mitral valve disease requires further assessment. The hemodynamic consequences are increased of left atrial pressure due to high transvalvular gradient causing pulmonary hypertension and leading to right ventricular dysfunction. The utilization of Right Ventricular Longitudinal Strain (RVLS) are more sensitive when assessed subclinical right ventricular dysfunction compared to standard parameters. It has been known the degree of mitral valve severity through MVA by planimetry, VCW and EROA are associated with RVLS in patients with mixed mitral valve disease due to RHD.

Method: This observational cross-sectional study involved 70 patients diagnosed with mixed mitral valve disease due to RHD at Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar with normal right ventricular function (TAPSE >1.75 cm and RV S’ > 9 cm/s) and then echocardiographic examination were conducted to assess MVA by planimetry, VCW, EROA and RVLS values

Results: A total of 70 samples were included in the analysis. A significant correlation was found between MVA by planimetry and RVLS (r=0.241; p=0.045), indicating as the the mitral valve area increased, the RVLS were increased. There was no correlation between VCW and RVLS (r=-0.079; p=0.513) and no correlation between EROA and RVLS (r=-0.069; p=0.570). This shows that mitral stenosis lesions are more prone to pulmonary hypertension through increased left atrial pressure and pulmonary artery systolic pressure, thereby increasing right ventricle afterload.

Conclusion: RVLS is an echocardiographic parameter which can assess subclinical right ventricular dysfunction, with MVA by planimetry as a significant correlating factor. On the other hand, VCW and EROA has been found no significant correlation. The application of RVLS can be used in the routine evaluation of right ventricular function and determined a more optimized management strategy for patients with mixed mitral valve disease due to RHD especially mitral stenosis lesions before intervention.