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Comprehensive Understanding of Mitral Regurgitation with Echocardiogram Modalities

Learn about mitral regurgitation, its echocardiogram assessment, modalities including transthoracic and transesophageal echo, etiologies, and indications for surgery. Dr. C.S. Mahlangu from University of Limpopo explains.

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Comprehensive Understanding of Mitral Regurgitation with Echocardiogram Modalities

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  1. ECHOCARDIOGRAM (ECHO) FOR MITRIAL REGURGITATION Dr C.S Mahlangu University of Limpopo(medunsa) Cardiothoracic registrar

  2. Definition • Pathologic back flow of blood from the LV to the LA. • Problem of leaflets,anulus or subvulvular apparatus

  3. Modalities

  4. Transthoracic echo PARASTERNAL LONG AXIS PARASTERNAL LONG AXIS PARASTERNAL LONG AXIS APICAL FOUR CHAMBER APICAL FOUR CHAMBER APICAL FOUR CHAMBER LV RV RA LA

  5. Transthoracic echo SHORT AXIS LV AT PAPPILARY LEVEL RV RV IVS IVS AL LVD PM LVPW LVPW

  6. Transoesophageal echo

  7. TEE • Use of TEE • Pre op • Intra op • Indications • Limitations • Intra op • MR assessment • Assessment of repair

  8. Monoplane transesophageal echocardiography LAA A1 Ao P1 A2 P2 A3 P3

  9. 3D transesophagealechocardiography

  10. Anatomic echo parameters • LV dimension/size • LA dilation • LV volume • Stroke volume • Valve abnormality

  11. LA SIZE APICAL 4 CHAMBER LV RV RA LA Normal size = 19-40mm

  12. LA SIZE PARASTERNAL LONG AXIS RV RV AO LV IAS LAD LA LA wall

  13. LV DIMENSIONS PARASTERNAL LONG AXIS RV IVS LV LVD LA NORMAL VALUES IVSd 6-12 LVEDD 36-52 LVPWd 6-11 IVSs 6-9 LVESD 24-42 LVPWs 9-14 LV EF 50-75% LVPW

  14. Colour flow doppler • Jet area • Jet area index to LA • Vena contracta width RV LA RA

  15. Central vs eccentric jet TRANSTHORACIC TRANSOESOPHAGEAL LV RV RA LA

  16. Pulmonary flow reversal RV RA

  17. Spectral doppler

  18. Etiologies of mitral regurgitation • Normal leaflet motion : • annular dilatation (LV dilatation, ischemia) • leaflet perforation (trauma, endocarditis, ostiumprimum ASD) • Excess leaflet motion : • mitral valve prolapse (Barlow’s disease, Marfansyndrom, Ehler-Danlossyndrom, pseudoxanthomaelasticum) • chordae rupture (prolapse, trauma, endocarditis) • papillary muscle rupture (infarction, trauma) • Restricted leaflet motion : • leaflet retraction (rheumatic fever, carcinoïd heart diasease, systemic lupus, annular calcifications, ...) • systolic anterior motion (HCOM) • chordae retraction (rheumatic disease) • papillary muscle retraction and/or dysfunction (aneurysm, infarction, ischemia, endomyocardial fibrosis)

  19. Various forms of mitral regurgitation Mitral prolapse in Barlow’s disease Mitral prolapse with ruptured chords Infective endocarditis Rheumatic disease

  20. Rheumatic RV LVOT LV LA

  21. Prolapse and flail leaflet MYXOMATOUS BARLOW’S DISEASE ISCHEMIC TRAUMA ENDOCARDITIS

  22. Annular dilatation PARASTERNAL LONG AXIS APICAL 4 CHAMBER RV LV LV LV LA RA LA

  23. MR severity

  24. Carpentier’s classification

  25. Indications for surgery

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