Mitral Leaflet Separation Revisited: A Surrogate of Mitral Valve Area in Young People With Rheumatic Mitral Regurgitation Living in Remote Areas

Delivering comprehensive echocardiographic evaluation of rheumatic heart disease (RHD) is challenging in remote locations, including remote Australian communities. Handheld ultrasound devices are often used to screen young people at high risk for RHD, and their utility is being extended to nonexpert users with limited technical expertise.1 The 2023 WHF (World Heart Federation) guidelines for diagnosis of rheumatic mitral stenosis (MS) include a mean transmitral pressure gradient (TMPG) of ≥4 mm Hg in conjunction with restricted leaflet motion and reduced valve opening.2 Quantification of leaflet restriction may be a useful measurement, particularly for nonexperts using handheld devices.