Mitral Regurgitation

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Mechanisms of Mitral Regurgitation

  • Anterior Leaflet Prolapse
  • Posterior Leaflet Prolapse
  • Bileaflet Prolapse
  • Restricted Leaflets
  • Apical Tethering
  • Ruptured Papillary Muscle
  • Ischemic Papillary Rupture
  • Leaflet Perforation

Assessment of Severity

Classification of Severity
Indicator Mild Moderate Severe
Angiographic Grade 1+ 2+ 3+
Vena Contracta Width <0.3 0.3 to 0.60 >.7
Regurgitant Orifice Area <0.2 0.2 to 0.39 >.4
  • Visual assessment by color
  • Measure PISA R squared/2
    • ERO > 0.4 severe
  • Doppler pulmonary veins for reversal
  • Mitral Inflow > 1.5 m/sec

Severe Mitral Regurgitation Ventriculogram

Quantification of Mitral Regurgitation by Ventriculography:

Both the RAO and LAO/Cranial projections can be used to identify significant mitral regurgitation. Grading the amount of regurgitation is based on the amount of opacification of the atrium compared to the ventricular opacification, atrial size and the number of cycles required for maximal opacification. Elevation of left atrial pressure in acute regurgitation and dilation of the left atrium from chronic regurgitation can both interfere with the use of this grading system.

1+  Brief and incomplete atrial opacification over several cycles. Clears rapidly. No atrial enlargement.

1+ MR 1+ MR LAO with SAM

2+  Moderate opacification of the atria with each cycle. Never greater than LV opacification. No significant LA enlargement.

2+ MR

3+ Atrial opacification equal to ventricular opacification.  Delayed clearing of atria over several cycles. Significant enlargement of the LA.

3-4+ MR 3+ MR

4+ Atrial Opacification immediate and greater than that of the ventricle.  Severe enlagement of the LA.  Opacification of the pulmonary veins.

4+ Paravalvular MR 4+ MR

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