From the Guidelines
No, diastolic doming of the mitral valve leaflet cannot be reliably diagnosed in the apical view. According to the 2014 AHA/ACC guideline for the management of patients with valvular heart disease 1, the characteristic diastolic doming of the mitral valve is typically identified using 2D scanning from the parasternal long-axis window.
Key Points to Consider
- The parasternal long-axis window is preferred for identifying diastolic doming of the mitral valve leaflet 1.
- The apical view is useful for assessing other aspects of mitral valve function, such as Doppler hemodynamics, which can provide information on peak and mean transvalvular gradient 1.
- The severity of mitral stenosis can be further assessed by measuring the mitral valve area using planimetry or pressure half-time methods, but this is not directly related to diagnosing diastolic doming in the apical view 1.
- It is essential to use the most appropriate echocardiographic view to accurately diagnose and assess mitral valve abnormalities, prioritizing the parasternal long-axis window for diastolic doming 1.
From the Research
Diagnosing Diastolic Doming of Mitral Valve Leaflet in Apical View
- The study 2 found that longitudinal cross-sectional echocardiography was superior to the apical view in assessing the diastolic doming motion of the anterior mitral leaflet.
- However, the study 3 identified a characteristic pattern of anterior leaflet motion, termed "reverse doming," which was seen in the apical and long-axis views in patients with moderately severe and severe aortic regurgitation.
- The study 4 assessed maximal diastolic mitral leaflet opening and inflow direction from the apical 4-chamber view and found that patients with diastolic MR had more restricted maximal diastolic leaflet openings and substantially smaller inflow angles compared with patients without diastolic MR.
- The studies 5 and 6 did not provide direct evidence for diagnosing diastolic doming of the mitral valve leaflet in the apical view, but they discussed the importance of echocardiography in assessing diastolic dysfunction and mitral valve function.
Echocardiographic Views and Diastolic Doming
- The apical view can be used to assess diastolic mitral leaflet motion, but its sensitivity and specificity may be limited compared to longitudinal cross-sectional echocardiography 2.
- The apical 4-chamber view can be used to assess maximal diastolic mitral leaflet opening and inflow direction, which can be useful in diagnosing diastolic MR 4.
- Reverse doming of the anterior mitral leaflet can be seen in the apical and long-axis views in patients with moderately severe and severe aortic regurgitation 3.