Posts Tagged ‘rhd’

Mitral regurgitation jets can take many shapes

  • Symmetrical
  • Central
  • Eccentric

The direction of the jet depends upon

  • The angle of co-optation
  • The  plane of  orientation of regurgitant  orifice . It  can be entirely off track with  physiological  mitral orifice .
  • Degree of prolapse or shortening /subvalvular  fusion.
  • Flail valve tips can guide the jet selectively into anterior/superior  or posterior aspect of LV

Rheumatic mitral valve showing poor leaflet co-optation.Patient is having significant tachycardia


Perpendicular 90 degree MR jets


In rheumatic heart disease  eccentric jets are more common. In dilated cardiomyopathy MR jets are often symmetrical and central as the pathology is annular dilatation.

What are  the significance of eccentric MR jets ?

  • Anterior jets clinically mimic aortic stenosis as the murmur is  often well conducted to neck
  • Murmurs of  posterior jets well conduct to axilla .
  • Eccentric jets are often acute and compromise hemodynamics
  • Suspect early infective endocarditis.Carefully look for vegetation.
  • Eccentric jets make it difficult /risky  for PTMC (Note : In Mitral stenosis  +  grade 1  MR   with central jets  one can safely do PTMC)
  • Severe eccentric jets can flood one of the pulmonary veins and result in unilateral or regional pulmonary hypertension or even lobar /segmental pulmonary edema

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RHD is the scourge of mankind . While a part of the world is suffering from glamorous  lifestyle disease ,a  significant  population (The country I live – India , included)  is suffering due to  “lack of any style” in their  life !  exposed to  primitive streptococcal infections  and end up in deadly destructive heart valve disease .

While , the  privileged  cardiologists make merry in cath labs  ,  a  few toil in the deep sub Sahara forests and the tropics  of Cambodia  to bring some sense and balance  to  cardiology literature.

Mankind will benefit  much more  these committed souls* than the pseudo-research that is happening world wide !

Of course ,  we should thank the NEJM to publish  such  precious articles !

The summary of this article goes something  like this

Echocardiography ,  if used widely in general population  ( more specifically in children)  can identify rheumatic fever early with high degree of precision .With penicillin prophylaxis we can reduce the RHD burden of our planet significantly.

The message may be simple, but in the modern world  people’s suffering  is not due to lack of  sophisticated health tools , but  “lack of common sense “

This article came in 2007, unfortunately it has not  generated the  desired  impact  among the cardiac care takers  .(While  a  mediocre ,  drug eluting stent can reach 1000 cath labs in 100 countries in a matter  of weeks!)

The World health organisation (WHO) is yet to formally adopt this new  echocardiographic criteria to diagnose Rheumatic fever .We expect  the WHO , to urgently formulate new guidelines for early detection of rheumatic fever .(It is better , we stop hanging on to Jones for over  half  century !)

Will the WHO be proactive ?

If a portable echo costing few thousand dolors can save  millions of life , let the WHO the bring an ordinance to supply  (liberally ) manpower and  machines  to  all those poor countries  which lack in basic health service , but infested with  free supply of  deadly land mines , outsourced arms and ammunition !

This study was performed in  Maputo Heart Institute  Mozambique , and Cambodia .



* Three cheers to Eloi Marijon, M.D., Phalla Ou, M.D., David S. Celermaje .

Chain of Hope

Travel online to Africa : A journey into human side of cardiology  . . .

The charity  that has adapted  Maputo Heart Institute  Mozambique

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