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Mitral valve

4-5 cm2

Aortic valve

3-4 cm2

Pulmonic valve

3.5-4.5 cm2

Tricuspid valve

5-8 cm2

Parameters for the Determination of the Severity of Mitral Regurgitation1

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Structural Parameters

LA size


Normal or dilated

Usually dilatedb

LV size


Normal or dilated

Usually dilatedb

Mitral leaflets or support apparatus

Normal or abnormal

Normal or abnormal

Abnormal, flail leaflet, or ruptured papillary muscle

Doppler Parameters

Color flow jet areac

Small, central jet (usually &lt;4 cm2 or <20% of LA area)


Large central jet (usually &gt;10 cm2 or >40% of LA area) or variable size wall-impinging jet swirling in LA

Mitral inflow–PW

A-wave dominantd


E-wave dominantd (E usually 1.2 m/s)

Jet density–CW

Incomplete or faint



Jet contour–CW


Usually parabolic

Early peaking–triangular

Pulmonary vein flow

Systolic dominancee

Systolic bluntinge

Systolic flow reversalf

Quantitative Parametersg

VC width (cm)




R Vol (mL/beat)


30-44, 45-59


RF (%)


30-39, 40-49


EROA (cm2)


0.20-0.29, 0.30-0.39


CW, continuous-wave Doppler; LA, left atrium; EROA, effective regurgitant orifice area; LV, left ventricle; PW, pulsed-wave Doppler; RF, regurgitant fraction; R Vol, regurgitant volume; VC, vena contracta.

aUnless there were other reasons for LA or LV dilation. Normal 2D measurements: LV minor axis ≤2.8 cm/m2, LV end-diastolic volume ≤82 mL/m2, maximal LA anteroposterior diameter ≤2 cm/m2, maximal LA volume ≤36 mL/m2.

bException: acute mitral regurgitation.

cAt a Nyquist limit of 50-60 cm/s.

dUsually above 50 years of age or in conditions of impaired relaxation, in the absence of mitral stenosis or other causes of elevated LA pressure.

eUnless other reasons for systolic blunting (eg, atrial fibrillation, elevated left atrial pressure).

fPulmonary venous systolic flow reversal is specific but not sensitive for severe MR.

gQuantitative parameters can help sub-classify the moderate regurgitation group into mild-to-moderate and moderate-to-severe.

Calculation of the Quantitative Parameters of Mitral Regurgitation

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  1. Vena Contracta

    Narrowest width of the mitral regurgitation jet as it emerges from the coaptation site of the leaflets

  2. Regurgitant Volume

    Image not available.

  3. Regurgitant Fraction

    Image not available.

  4. Effective Regurgitant Orifice Area (EROA)

    Image not available.

  5. Proximal Isovelocity Surface Area

    Image not available.

Parameters for the Determination of the Severity of Mitral Stenosis2

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Mean pressure gradient (mm Hg)




Pressure half-time (ms)




Mitral valve area (cm2)




Pulmonary artery pressure (mm Hg)




Mitral valve resistance (−5)


Methods for Determining Mitral Valve Area (MVA)

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  1. Planimetry

    Tracing the mitral orifice obtained from the TG basal SAX view

  2. Pressure Gradient

    Tracing the entire envelope of the CWD spectrum of mitral inflow, from the beginning of early ...

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