Echocardiography

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    Mitral Regurgitation

    • Grading Severity
      • Looking at color jet:
        • Area of color jet over the LA: >40%
        • If LA enlarged = underestimates
      • Vena Contracta
        • The narrowest point of the jet (just below mitral valve)
        • To measure: Use parasternal long, zoom,
        • >0.7cm = severe
      • Pulmonary Veins
        • See S and D waves -
          • S (mitral valve pulled towards apex during systole, piston-like effect to pull blood)
          • Blunted in severe MR
        • Blunted systolic flow, or flow reversal (see in all 4 pulmonary veins)
      • Mitral Inflow CW Doppler
        • Usually, regurgitation CW tracing is parabolic (rounded), pointy = worse. 
        • Slope of regurgitation - onset straight down (low slope= poor EF)
          • get dP/dT (change in pressure over time) [measure between 1m/s to 3m/s]
          • Limitation: assumes isovolumetric contraction (which isn't the case)
        • Peak Velocity:
          • Can infer LA pressure
        • Inflow: peak inflow velocity (>200 = severe)
      • PISA - isovelocity area of flow convergence
        • Va is the velocity at which aliasing occurs in the flow convergence towards the regurgitant orifice
      • Regurgitant Fraction
    • Mitral valve prolapse:
      • Different because normally MR is pansystolic
      • In MVP the mitral valve is closed in early systole, but then prolapses and regurgitates.
      • Regurgitant area stays the same.
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