Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++|PrintMitral valve4-5 cm2Aortic valve3-4 cm2Pulmonic valve3.5-4.5 cm2Tricuspid valve5-8 cm2 +++ Parameters for the Determination of the Severity of Mitral Regurgitation1 ++|PrintMildModerateSevereStructural ParametersLA sizeNormalaNormal or dilatedUsually dilatedbLV sizeNormalaNormal or dilatedUsually dilatedbMitral leaflets or support apparatusNormal or abnormalNormal or abnormalAbnormal, flail leaflet, or ruptured papillary muscleDoppler ParametersColor flow jet areacSmall, central jet (usually <4 cm2 or <20% of LA area)VariableLarge central jet (usually >10 cm2 or >40% of LA area) or variable size wall-impinging jet swirling in LAMitral inflow–PWA-wave dominantdVariableE-wave dominantd (E usually 1.2 m/s)Jet density–CWIncomplete or faintDenseDenseJet contour–CWParabolicUsually parabolicEarly peaking–triangularPulmonary vein flowSystolic dominanceeSystolic bluntingeSystolic flow reversalfQuantitative ParametersgVC width (cm)<0.30.3-0.69≥0.7R Vol (mL/beat)<3030-44, 45-59≥60RF (%)<3030-39, 40-49≥50EROA (cm2)<0.200.20-0.29, 0.30-0.39≥0.40CW, 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 ++|PrintVena ContractaNarrowest width of the mitral regurgitation jet as it emerges from the coaptation site of the leafletsRegurgitant VolumeRegurgitant FractionEffective Regurgitant Orifice Area (EROA)Proximal Isovelocity Surface Area +++ Parameters for the Determination of the Severity of Mitral Stenosis2 ++|PrintIndicatorMildModerateSevereMean pressure gradient (mm Hg)<55-10>10Pressure half-time (ms)90-150150-219>220Mitral valve area (cm2)>1.51.0-1.5<1.0Pulmonary artery pressure (mm Hg)<3030-50>50Mitral valve resistance (dyne.s.cm−5)>85 +++ Methods for Determining Mitral Valve Area (MVA) ++|PrintPlanimetryTracing the mitral orifice obtained from the TG basal SAX viewPressure GradientTracing the entire envelope of the CWD spectrum of mitral inflow, ... 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.