N N

N or Abnormal

Small, central jet (usually <4 cm2 or <20% of left atrium area)

Mitral E- point velocity - PW A-wave dominant

Incomplete or faint parabolic

Systolic dominance

N or Dilated N or Dilated N or abnormal

Variable Variable

Variable Dense

Usually parabolic Systolic blunting

Usually D

Usually D

Abnormal/Flail leaflet/Ruptured papillary muscle

Large central jet (usually >10 cm2 or >40% left atrium area) or variable size wall-impinging jet swirling in left atrium

Dense

Early peaking-triangular

Systolic flow reversal

Modified from ASE, American Society of Echocardiography Report (2003)—ASE/ACC/AHA/ESC Guidelines. See ref. 3.

fibrosis and thickening of leaflets and chordae that lead to mitral stenosis also prevent normal mitral leaflet coaptation during systole. Combined mitral stenosis-MR is the result. (Fig. 12; see Chapter 13, Table 3).

assessment of mr severity

A comprehensive assessment of a patient with MR should pay special attention to ventricular performance, with emphasis on the parameters of LA systolic function (see Chapter 5).

In addition to defining etiological and anatomic mechanisms of MR, assessment of MR severity and its hemodynamic impact on risk stratification and timing of intervention (Table 4).

The American Society of Echocardiography guidelines for the classification of grades of MR severity are shown in Table 5. Although the recommendation to grade MR severity is mild, moderate and severe, distinguishing mild from moderate and moderate from severe can be challenging. Thus, several qualititative and quantitive measures have been proposed, although limitations of each should be noted during their use; the most popular methods in use will be further delineated in this chapter. For example, most of the Doppler-based parameters apply only to isolated MR, and not to mixed valvular lesions, or MR secondary to LV dysfunction. Quantitative assessment of MR using these methods may involve relatively complex calculations,

Normal Acute MR

Chronic compensated MR Chronic decompensated MR

Fig. 13. Mitral regurgitation and the left ventricle: three phases of dysfunction. (Modified from Carabello BA. Progress in mitral and aortic regurgitation. Curr Probl Cardiol 2003;28:553.)

Chronic compensated MR Chronic decompensated MR

Fig. 13. Mitral regurgitation and the left ventricle: three phases of dysfunction. (Modified from Carabello BA. Progress in mitral and aortic regurgitation. Curr Probl Cardiol 2003;28:553.)

Table 6

Recommended Echocardiography Follow-up in Chronic Asymptomatic MR

Table 6

Recommended Echocardiography Follow-up in Chronic Asymptomatic MR

MR severity

LV size

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