How to diagnose and assess severity of mitral regurgitation by echo
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How to Diagnose and Assess Severity of Mitral Regurgitation by Echo PowerPoint PPT Presentation


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How to Diagnose and Assess Severity of Mitral Regurgitation by Echo. Noel Black Chief Cardiac Physiologist South Eastern Trust. Modalities. 2D and M-Mode Colour Doppler Pulsed Wave and Continuous Wave Doppler 3D. M-Mode. Left atrial dilatation Left ventricular dilatation

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How to Diagnose and Assess Severity of Mitral Regurgitation by Echo

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How to Diagnose and Assess Severity of Mitral Regurgitation by Echo

Noel Black

Chief Cardiac Physiologist

South Eastern Trust


Modalities

  • 2D and M-Mode

  • Colour Doppler

  • Pulsed Wave and Continuous Wave Doppler

  • 3D


M-Mode

  • Left atrial dilatation

  • Left ventricular dilatation

  • Left ventricular volume overload pattern

  • Increased D-E amplitude of the mitral valve anterior leaflet


2-D

  • Status of the Mitral Valve Apparatus

    • Leaflet prolapse

    • Rheumatic disease

    • Myxomatous degeneration


Organic Aetiology

  • Calcification

  • Vegetation

  • Mass


Functional Ischaemic

  • Left ventricular impairment

    • Chordal/papillary muscle involvement


Functional. LV/LA dilatation

  • Mitral annular dilatation (normal 2.3+- 0.5cm) A4Ch view

  • LA dilatation

  • LV dilatation


Disease Process

Aetiology

Mechanism Non-Ischaemic Ischaemic

Organic Rheumatic Ruptured PM

Prolapse

Endocarditis

Flail leaflet

Functional Cardiomyopathy Post-MI


Colour Flow Doppler

  • 1.Flow distribution (jet size)

  • 2.Vena contracta

  • 3.PISA


1.Flow distribution

  • How far the regurgitant jet extends into the LA.

  • Trace area of the jet and LA

    • Jet area (cm)2

      • Severe MR: >10

    • Jet area / LA (%)

      • Severe MR: >40


Colour Flow Doppler

  • Jet position in relation to the mitral leaflets.

    • Evidence of leaflet perforation.

    • Multiple or single jets


The direction of the regurgitant jet

Centrally

anteriorly

posteriorly directed.

Away from abnormal leaflet.

Colour doppler


Consider Image quality

  • Poor image quality may underestimate severity


Consider –Jet direction

Direction of the Jet (entrainment effect)

  • Central jet overestimated

  • Eccentric jet underestimated


Influence of Colour Gain Settings on Colour jet size -50-60 cm/s


Consider Frame rate- Sector and colour box size


2.Vena Contracta width

  • Narrowest region at the mitral valve level

  • 2 planes

  • Nyquist 50-60 cm/s

  • Zoom to optimise visualisation

  • Colour sector as narrow as possible

  • Maximal lateral and temporal resolution

    • Mild MR :

    • VC <0.3cm

    • Severe MR :

      VC >0.7cm


Consideration

  • VC width is inaccurate with multiple jets


Consideration

  • VC should not be measured in Apical 2Ch view

    • Parallel to the mitral orifice.

    • Overestimation.


3.Proximal Isovelocity surface area (PISA)

  • Hemishells

  • Flow convergence area

  • Increases with severity of regurgitation


Calculating (PISA)

  • Apical 4Ch view

  • Narrow sector width

  • Minimise depth

  • Zoom

  • Adjust Colour Doppler alaising velocity (20-40 cm/s)


PISA

  • Measure the radius of the hemisphere. (red/blue interface)

    • PISA radius =2πr2 (cm2)

      • Mild MR: <0.4

      • Severe MR:>1.0


Consideration

Non-circular orifice


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