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. 2022 Apr 12;9:862044. doi: 10.3389/fcvm.2022.862044

FIGURE 5.

FIGURE 5

Mitral regurgitation assessment by echocardiography and cardiac magnetic resonance imaging. Complex evaluation of moderate-severe mitral regurgitation (MR) with multiple jets in a patients with bileaflet mitral valve prolapse. (A) 2D transthoracic echocardiography using color flow Doppler shows two MR jets—an eccentric jet toward the intra-atrial septum and a jet toward the lateral wall. The PISA radius was measured at 8 mm, but given the multiple and eccentric jets, this parameter is not reliable to calculate the EROA and MR volume, which indicates the need for further evaluation using CMR. (B) CMR images of the same patient as in panel (A). Three-chamber cine image shows the presence of MR with two jets (upper left image). MR volume was calculated at 33 mL using the indirect method based on the difference between LV stroke volume (EDV—ESV = 160 mL) and aortic forward volume (127 mL). The LV stroke volume was calculated from the short-axis cine images in end-diastole and end-systole (lower right images) and the aortic flow was calculated by phase-contrast imaging (lower left image). Traditionally the LV base is defined at the level of the mitral valve annulus (yellow line, upper right images) and therefore the calculated regurgitant volume includes both the transvalvular MR volume and the prolapse volume. MR, mitral regurgitation; PISA, proximal isovelocity surface area; EROA, effective regurgitant orifice area; CMR, cardiac magnetic resonance imaging; LV, left ventricle; ED, end-diastolic; ES, end-systolic; EDV, end-diastolic volume; ESV, end-systolic volume.