Valvular Regurgitation - General

Primary regurgitation

– problem with the valve leaflets, e.g., rheumatic, age related, inflammation, congenital, therapy.

• Functional or secondary –

– The valve morphology is normal but there is a problem with supporting structures, e.g., ischemic heart disease and papillary muscle dysfunction and annular dilation.

Chronic regurgitation

results in chamber dilation with normal pressures

Acute regurgitation

results in normal chamber size with a sudden increase in pressure

Chronic mitral regurgitation will eventually lead to

o pulmonary hypertension and heart failure Increased afterload over time will lead to left ventricular hypertrophy

Regurgitation leads to

volume overload.

Left Ventricular Volume Overload

dilated left ventricle and hyperdynamic function

Right Ventricular Volume Overload

dilated right ventricle and paradoxical septal motion

Stenosis leads to

pressure overload.

Spectral Doppler waveform density –

the more severe results in a more prominent or dense spectral Doppler waveform.

• Flow convergence or PISA

– the flow velocity before the valve – small or none with mild regurgitation and more prominent when more significant regurgitation is present.

• Jet –

jet area and length, central or eccentric.

• Vena Contracta –

– the narrowest part of the jet at the valve leaflet tips.

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