Echocardiography

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.