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. 2021 Jul 8;8:706165. doi: 10.3389/fcvm.2021.706165

Table 3.

Pre-operative echocardiographic checklist for planning mitral regurgitation surgery (6, 18, 19).

Pre-operative checklist
Patient : ____________________________
Type of Intervention : _____________________________
Date : _____________________
Bidimensional Echocardiography: transthoracic
transesophageal
Parameter Measure Normal values
Anatomic measures
Mitral annular dimension
- Diameter (PSAX in diastole) <35 mm
- Annulus area 5–11 cm2
Annulus/anterior leaflet ratio <1.3
Number of involved scallops
Calcification (++++ max.)
Coaptation point-to-septum distance ≥2.5 cm
Mitral-aortic angle (°) 136 ± 13 end-diastole
129 ± 11 end-systole
IVS thickness (mm) <11 mm
Subaortic spur (yes/no and mm) No
LVOT measure (mm) 20 ± 2
Leaflet length (mm)
Anterior leaflet (AL) ≥26
Posterior leaflet (PL) <15
AL/PL ratio >1.3
PL angle (°) <45
Chordae length (mm)
Segments height (P1–P3, cm) <1.5
Tenting area (cm2) <2.5
Asymmetric tenting (yes/no)
Functional measures
LV EDD (mm) 42–59
LV EDD/BSA (mm/m2) 2.2–3
LV ESV (ml) 21–61
LV ESV/BSA (ml/m2) 11–31
LV EF (%) 55–60%
LV GLS (%) ≥-20%
LAVI (ml/m2) 16–34
PALS (%) ≥39%
fwRVLS (%) ≥-20%
3D transesophageal echocardiography
VCA (cm2) ≤ 0.4 (cut-off for severe MR)
Presence of cleft/indentation No
A2 height (mm) ≤ 26
P2 height (mm) <20
Inter-trigonal distance (mm) 30 ± 3

BSA, body-surface area; EDD, end-diastolic diameter; EF, ejection fraction; ESV, end-systolic volume; fwRVLS, free-wall right ventricular longitudinal strain; GLS, global longitudinal strain; IVS, interventricular septum; LAVI, left atrial volume index; LV, left ventricular; LVOT, left ventricular outflow tract; PALS, peak atrial longitudinal strain; PSAX, parasternal short axis; VCA, vena contracta area.