Mitral Facies: A Case Report

A 42-year-old woman presented with sudden weakness of left side. Her medical history was rheumatic mitral stenosis 8 years ago. On physical examination was remarkable her rosy cheeks, whilst the rest of the face has a bluish tinge called Mitral Face. It is the classic facial appearance in mitral stenosis, a plum-colored malar flush, occurs only when cardiac output is low and pulmonary hypertension is severe; cause is cutaneous vasodilation and chronic hypoxemia. In addition to cardiac auscultation was an irregularly irregular rhythm, a loud S1 and accentuated P2, an opening snap, and a III/IV decrescendo diastolic rumble at the apex. Transthoracic echocardiography revealed findings typical of rheumatic mitral stenosis. The mitral leaflets were pliable, with restricted mobility of the leaflet tips, resulting in doming and a “hockey-stick” appearance of the anterior leaflet in diastole. There was notable subvalvular thickening. Cross-sectional imaging of the stenotic orifice demonstrated thickening restricted to the leaflet tips. Continuous-wave Doppler ultrasonography demonstrated a transvalvular gradient persistent throughout diastole, with a mean transvalvular gradient of 14.6 mm Hg. The estimated valve area was 0.9 cm2 on direct planimetry of the restrictive orifice. Systolic pulmonary artery pressure was 45 mmHg.