Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ NORMAL VALVE AREAS ++ Table Graphic Jump Location|Download (.pdf)|Print Mitral valve 4–5 cm2 Aortic valve 3–4 cm2 Pulmonic valve 3.5–4.5 cm2 Tricuspid valve 5–8 cm2 +++ MITRAL VALVE +++ Parameters for Determining the Severity of Mitral Regurgitation1 ++ Table Graphic Jump Location|Download (.pdf)|Print MR severity* Mild Moderate Severe Structural MV morphology None or mild leaflet abnormality (e.g., mild thickening, calcifications or prolapse, mild tenting) Moderate leaflet abnormality or moderate tenting Severe valve lesions (primary: flail leaflet, ruptured papillary muscle, severe retraction, large perforation; secondary: severe tenting, poor leaflet coaptation) LV and LA size† Usually normal Normal or mildly dilated Dilated‡ Qualitative Doppler Color flow jet area§ Small, central, narrow, often brief Variable Large central jet (>50% of LA) or eccentric wall-impinging jet of variable size Flow convergence‖ Not visible, transient or small Intermediate in size and duration Large throughout systole CWD jet Faint/partial/parabolic Dense but partial or parabolic Holosystolic/dense/triangular Semiquantitative VCW (cm) <0.3 Intermediate ≥0.7 (>0.8 for biplane)¶ Pulmonary vein flow# Systolic dominance (may be blunted in LV dysfunction or AF) Normal or systolic blunting# Minimal to no systolic flow/systolic flow reversal Mitral inflow** A-wave dominant Variable E-wave dominant (>120 cm/s) Quantitative††,‡‡ EROA, 2D PISA (cm2) <0.20 0.20–0.29 0.30–0.39 ≥0.40 (may be lower in secondary MR with elliptical ROA) RVol (mL) <30 30–44 45–59†† ≥60 (may be lower in low-flow conditions) RF (%) <30 30–39 40–49 ≥50 Abbreviations: ROA, Regurgitant orifice area.Bolded qualitative and semiquantitative signs are considered specific for their MR grade.*All parameters have limitations, and an integrated approach must be used that weighs the strength of each echocardiographic measurement. All signs and measures should be interpreted in an individualized manner that accounts for body size, sex, and all other patient characteristics.†This pertains mostly to patients with primary MR.‡LV and LA can be within the “normal” range for patients with acute severe MR or with chronic severe MR who have small body size, particularly women, or with small LV size preceding the occurrence of MR.§With Nyquist limit 50–70 cm/s.‖Small flow convergence is usually <0.3 cm, and large is ≥1 cm at a Nyquist limit of 30–40 cm/s.¶For average between apical two- and four-chamber views.#Influenced by many other factors (LV diastolic function, atrial fibrillation, LA pressure).**Most valid in patients >50 years old and is influenced by other causes of elevated LA pressure.††Discrepancies among EROA, RF, and RVol may arise in the setting of low- or high-flow states.‡‡Quantitative parameters can help subclassify the moderate regurgitation group. +++ Calculation of the quantitative parameters of mitral regurgitation ++ Vena Contracta Narrowest width of the mitral regurgitation jet as it emerges from ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.