|
Qualitative
|
| Mitral valve morphology |
Flail leaflet, ruptured papillary muscle, severe retraction, large perforation |
Normal leaflets but with severe tenting, poor leaflet coaptation |
| Colour flow jet area |
Large central jet (>50% of LA) or eccentric wall impinging jet of variable size |
Large central jet (>50% of LA) or eccentric wall impinging jet of variable size |
| Flow convergence |
Large throughout systole |
Large throughout systole |
| Continuous wave Doppler jet |
Holosystolic/dense/triangular |
Holosystolic/dense/triangular |
|
Semiquantitative
|
| Vena contracta width (mm) |
≥7 (≥8 mm for biplane) |
≥7 (≥8 mm for biplane) |
| Pulmonary vein flow |
Systolic flow reversal |
Systolic flow reversal |
| Mitral inflow |
E-wave dominant (>1.2 m/s) |
E-wave dominant (>1.2 m/s) |
| TVI mitral/TVI aortic |
>1.4 |
>1.4 |
|
Quantitative
|
| EROA (2D PISA, mm2) |
≥40 mm2
|
≥40 mm2 (may be ≥30 mm2 if elliptical regurgitant orifice area) |
| Regurgitant volume (mL/beat) |
≥60 mL |
≥60 mL (may be ≥45 mL if low flow conditions) |
| Regurgitant fraction (%) |
≥50% |
≥50% |
|
Structural
|
| Left ventricle |
Dilated (ESD ≥40 mm) |
Dilated |
| Left atrium |
Dilated (diameter ≥55 mm or volume ≥60 mL/m2) |
Dilated |
| 2D: two-dimensional; ESD: endsystolic diameter; EROA: effective regurgitant orifice area; LA: left atrium; PMR: primary mitral regurgitation; SMR: secondary mitral regurgitation; PISA: proximal isovelocity surface area; TVI: time-velocity integral. Adapted from Lancellotti P et al. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2013;14:611-644. Copyright (2013) by permission of Oxford University Press on behalf of the European Society of Cardiology. Reproduced from Zoghbi WA et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2017;30:303-371. Copyright (2017), with permission from the American Society of Echocardiography. |
