The presence of decreased systolic left ventricular function can alter the reliability of Doppler in assessing the true gradient across the aortic valve. The next point of attention in the parasternal long axis view is usually the mitral valve apparatus. The classic mitral stenosis hockey stick appearance of the anterior mitral leaflet is rare, but can clarify the clinical diagnosis of congestive heart failure. The dyspnea is secondary to pulmonary congestion but systolic left ventricular function may well be normal. The most common abnormality on color Doppler related to the patient with congestive heart failure may be some degree of mitral insufficiency.
Mitral insufficiency can be either primary or secondary to the heart failure.
Primary mitral insufficiency resulting in heart failure needs to be evaluated for etiology. This can become apparent in some patients in the parasternal long axis view immediately after placing the transducer on the chest. For example, the patient can have mitral insufficiency secondary to mitral valve prolapse . Secondary mitral insufficiency in the patient with congestive heart failure may be due to a dilated left ventricle that has caused dilatation of the mitral annulus with alteration of the mitral leaflet coaptation and some degree of mitral insufficiency. Conversely, a commonly overlooked cause of heart failure, especially in older patients, is not a systolic problem, but rather a diastolic problem.