Imaging

• TTE (pre-diagnosis/intervention)
• TEE  (pre-diagnosis/intervention)
• Presenting both together, per valve

Ventricles

Left Ventricle

• Normal function, EF 63%
• Mildly dilated by volume
• D shaped appearance

TTE

Left Ventricle

• Normal function, EF 63%
• Mildly dilated by volume
• D shaped appearance

TTE

Right Ventricle

• Normal size and function

TTE

Valves

Aortic Valve

TTE

Aortic Valve

TEE

Aortic Valve

TEE

Aortic Valve

• Tricuspid and thickened valve
• RCC thickened and immobile
• Moderate regurgitation, no stenosis

TEE

Mitral Valve

TTE

Mitral Valve

TTE

Mitral Valve

TEE

Mitral Valve

TEE

• Immobile PMVL
• Mild thickening of subchordal apparatus
• Severe regurgitation, no stenosis

Tricuspid Valve

TTE

Tricuspid Valve

TEE

Tricuspid Valve

TEE

• Restricted motion of anterior leaflet
• No thickening of subchordal apparatus
• Severe regurgitation, no stenosis

Pulmonary Valve

TTE

• Mildly reduced excursion of leaflets
• Mild stenosis
• Moderate regurgitation

Summary

• Normal LV and RV function
• Immobile posterior mitral valve leaflet
  • Severe MR
• Aortic valve with thickened cusps and restricted RCC
  • Moderate AR
• Restricted motion of anterior tricuspid leaflet
  • Severe TR
• Thickened pulmonary valve with reduced excursion
  • Mild PS, Moderate PR
• No shunt seen by 2D, colour Doppler or bubble study

Differential

• Findings are consistent with post-inflammatory changes

• Differential:

  • Rheumatic heart disease (most common)

  • SLE, other autoimmune conditions

  • Radiation exposure/injury

  • Carcinoid heart disease

  • Drug-induced valvulopathy (eg. ergot alkaloids)

  • Endocarditis (infective/non-infective

Carcinoid Heart Disease

UTD

Carcinoid Heart Disease

UTD

Carcinoid Heart Disease

Rheumatic Heart Disease

Rheumatic Heart Disease

UTD

Rheumatic Heart Disease

UTD