Table of contents
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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)
- See S and D waves -
- 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
- Looking at color jet:
- 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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