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A 39 year-old female was admitted with complaints of dyspnoea on exertion (NYHA-II) for one year. The patient also had history of orthopnoea and paroxysmal nocturnal dyspnoea. She was in atrial fibrillation with a heart murmur consistent with mitral stenosis.TTE showed a dilated left atrium with severe rheumatic mitral stenosis (MVA 0.8 sq cm).Marked spontaneous echocardiographic contrast in the left atrium flowing through a stenotic mitral valve was seen, giving the appearance of asmoking mitral valve (Figure 1 and 2). Transoesophageal echocardiography (TEE) corroborated the finding of TTE including spontaneous echocardiographic contrast (SEC) in left ventricle. In conditions with slow blood-flow or stasis, spontaneous echocardiographic contrast is seen, which is a characteristic echocardiographic phenomenon with a very distinct smoke-like swirling pattern.1 SEC is an indicator of increased thromboembolic risk.Figure 1: Apical four-chamber view showing thickened calcified rheumatic mitral leaflets with dilated left atrium and spontaneous echocardiographic contrast (smoking mitral valve).Figure 2: Parasternal long-axis view showing thickened calcified rheumatic mitral leaflets with dilated left atrium, hockey stick shaped anterior mitral leaflet andsmoking mitral valve.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Animesh Mishra, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India; Manish Kapoor, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India; Tony Ete, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India; Gaurav Kavi, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India; Pravin Jha, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India; Rondeep Nath Sivam, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India.

Acknowledgements

Correspondence

Dr Tony Ete, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong 793018, India.

Correspondence Email

tetepete@gmail.com

Competing Interests

Nil.

- - Salahuddin S, Ramakrishnan S, Seth S, Bhargava B.Smoking mitral valve. J Am Coll Cardiol. 2012 Sep 11; 60:11.- -

For the PDF of this article,
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View Article PDF

A 39 year-old female was admitted with complaints of dyspnoea on exertion (NYHA-II) for one year. The patient also had history of orthopnoea and paroxysmal nocturnal dyspnoea. She was in atrial fibrillation with a heart murmur consistent with mitral stenosis.TTE showed a dilated left atrium with severe rheumatic mitral stenosis (MVA 0.8 sq cm).Marked spontaneous echocardiographic contrast in the left atrium flowing through a stenotic mitral valve was seen, giving the appearance of asmoking mitral valve (Figure 1 and 2). Transoesophageal echocardiography (TEE) corroborated the finding of TTE including spontaneous echocardiographic contrast (SEC) in left ventricle. In conditions with slow blood-flow or stasis, spontaneous echocardiographic contrast is seen, which is a characteristic echocardiographic phenomenon with a very distinct smoke-like swirling pattern.1 SEC is an indicator of increased thromboembolic risk.Figure 1: Apical four-chamber view showing thickened calcified rheumatic mitral leaflets with dilated left atrium and spontaneous echocardiographic contrast (smoking mitral valve).Figure 2: Parasternal long-axis view showing thickened calcified rheumatic mitral leaflets with dilated left atrium, hockey stick shaped anterior mitral leaflet andsmoking mitral valve.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Animesh Mishra, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India; Manish Kapoor, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India; Tony Ete, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India; Gaurav Kavi, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India; Pravin Jha, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India; Rondeep Nath Sivam, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India.

Acknowledgements

Correspondence

Dr Tony Ete, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong 793018, India.

Correspondence Email

tetepete@gmail.com

Competing Interests

Nil.

- - Salahuddin S, Ramakrishnan S, Seth S, Bhargava B.Smoking mitral valve. J Am Coll Cardiol. 2012 Sep 11; 60:11.- -

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

A 39 year-old female was admitted with complaints of dyspnoea on exertion (NYHA-II) for one year. The patient also had history of orthopnoea and paroxysmal nocturnal dyspnoea. She was in atrial fibrillation with a heart murmur consistent with mitral stenosis.TTE showed a dilated left atrium with severe rheumatic mitral stenosis (MVA 0.8 sq cm).Marked spontaneous echocardiographic contrast in the left atrium flowing through a stenotic mitral valve was seen, giving the appearance of asmoking mitral valve (Figure 1 and 2). Transoesophageal echocardiography (TEE) corroborated the finding of TTE including spontaneous echocardiographic contrast (SEC) in left ventricle. In conditions with slow blood-flow or stasis, spontaneous echocardiographic contrast is seen, which is a characteristic echocardiographic phenomenon with a very distinct smoke-like swirling pattern.1 SEC is an indicator of increased thromboembolic risk.Figure 1: Apical four-chamber view showing thickened calcified rheumatic mitral leaflets with dilated left atrium and spontaneous echocardiographic contrast (smoking mitral valve).Figure 2: Parasternal long-axis view showing thickened calcified rheumatic mitral leaflets with dilated left atrium, hockey stick shaped anterior mitral leaflet andsmoking mitral valve.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Animesh Mishra, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India; Manish Kapoor, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India; Tony Ete, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India; Gaurav Kavi, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India; Pravin Jha, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India; Rondeep Nath Sivam, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India.

Acknowledgements

Correspondence

Dr Tony Ete, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong 793018, India.

Correspondence Email

tetepete@gmail.com

Competing Interests

Nil.

- - Salahuddin S, Ramakrishnan S, Seth S, Bhargava B.Smoking mitral valve. J Am Coll Cardiol. 2012 Sep 11; 60:11.- -

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for the PDF of this article

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