Mitral Regurgitation

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Last updated 4:20 PM on 9/9/26
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23 Terms

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2D Features of MR

LA & LV enlargement

Thickened leaflets

Domed/stenotic leaflets (decreased movement or flailing)

<p>LA &amp; LV enlargement</p><p>Thickened leaflets</p><p>Domed/stenotic leaflets (decreased movement or flailing)</p>
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Regurgitant Jet Area (RJA) of MR

Best measured in apical view

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Mild MR RJA

< 20% of LA area

<p>&lt; 20% of LA area</p>
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Severe MR RJA

> 50% of LA area

<p>&gt; 50% of LA area</p>
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Vena Contracta

Narrowest cross-sectional area of regurgitant jet in color Doppler

Located just after then regurgitant orifice (ERO)

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Measuring Vena Contracta Width (VCW)

Zoomed in PLAX (or apical 4 chamber if needed) - NEVER use apical 2 chamber

Should see convergence, neck, and MR jet in image

Measure the width of the neck/narrowest diameter of the jet

<p>Zoomed in PLAX (or apical 4 chamber if needed) - NEVER use apical 2 chamber</p><p>Should see convergence, neck, and MR jet in image</p><p>Measure the width of the neck/narrowest diameter of the jet</p>
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Mild MR VCW

< 0.3 cm

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Severe MR VCW

≥ 0.7 cm

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Mild MR Doppler Features

Faint, soft, or incomplete jet

Peaks at mid-cycle

<p>Faint, soft, or incomplete jet</p><p>Peaks at mid-cycle</p>
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Moderate MR Doppler Features

Somewhat bright signal with dense areas

Parabolic-shaped

<p>Somewhat bright signal with dense areas</p><p>Parabolic-shaped</p>
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Severe MR Doppler Features

Bright, dense signal

Triangular-shaped

<p>Bright, dense signal</p><p>Triangular-shaped</p>
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Normal Pulmonary Vein Doppler Flow

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Pulmonary Vein Features of Mild MR

Dominant A-wave inflow pattern

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Pulmonary Vein Features of Severe MR

Flow reversal in systole

> 1 pulmonary vein contains flow reversal (look at all 4)

<p>Flow reversal in systole</p><p>&gt; 1 pulmonary vein contains flow reversal (look at all 4)</p>
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Proximal Isovelocity Surface Area (PISA)

Measures effective regurgitant orifice area (EROA) and calculates the volume of blood being regurgitated

Uses the area of color flow convergence

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How to Measure PISA for MR

Zoomed apical 4 chamber view

Lower Nyquist limit (30-40 cm/s)

Measure convergence radius - must be hemisphere/circular

Measure MR VTI & peak velocity

<p>Zoomed apical 4 chamber view</p><p>Lower Nyquist limit (30-40 cm/s)</p><p>Measure convergence radius - must be hemisphere/circular</p><p>Measure MR VTI &amp; peak velocity</p>
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PISA Radius of Severe MR

> 1 cm

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Limitations of PISA

Multiple jets - can't use if more than 1 jet

Poor sphere convergence

Eccentric jet

Measuring radius at the same point in cardiac cycle as peak MR velocity

MR must be holosystolic

Accompanying AI can cause measurement problems

Unit conversions (should be automatic on machine)

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Regurgitant Fraction

Only use if PISA can't differentiate severity

Compares stroke volume of MV annulus to LVOT flow

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Regurgitant Fraction for Mild MR

< 30%

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Regurgitant Fraction for Severe MR

≥ 50%

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Advantages of Regurgitant Fraction

Can assess multiple & eccentric jets

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Pressure Changes with MR

Increased LA pressure

Decreased LV pressure

<p>Increased LA pressure</p><p>Decreased LV pressure</p>