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Appendix D. Native Valve Areas, Velocities, and Gradients

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    AMA Citation
    Appendix D. Native Valve Areas, Velocities, and Gradients. In: Mathew JP, Swaminathan M, Ayoub CM. Mathew J.P., Swaminathan M, Ayoub C.M. Eds. Joseph P. Mathew, et al.eds. Clinical Manual and Review of Transesophageal Echocardiography, 2e New York, NY: McGraw-Hill; 2010. http://accessanesthesiology.mhmedical.com/content.aspx?bookid=417&sectionid=40109097. Accessed May 26, 2020.
    MLA Citation
    . "Appendix D. Native Valve Areas, Velocities, and Gradients." Clinical Manual and Review of Transesophageal Echocardiography, 2e Mathew JP, Swaminathan M, Ayoub CM. Mathew J.P., Swaminathan M, Ayoub C.M. Eds. Joseph P. Mathew, et al. New York, NY: McGraw-Hill, 2010, http://accessanesthesiology.mhmedical.com/content.aspx?bookid=417&sectionid=40109097.

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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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Mild

Moderate

Severe

Structural Parameters

LA size

Normala

Normal or dilated

Usually dilatedb

LV size

Normala

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)

Variable

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

Variable

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

Jet density–CW

Incomplete or faint

Dense

Dense

Jet contour–CW

Parabolic

Usually parabolic

Early peaking–triangular

Pulmonary vein flow

Systolic dominancee

Systolic bluntinge

Systolic flow reversalf

Quantitative Parametersg

VC width (cm)

<0.3

0.3-0.69

≥0.7

R Vol (mL/beat)

<30

30-44, 45-59

≥60

RF (%)

<30

30-39, 40-49

≥50

EROA (cm2)

<0.20

0.20-0.29, 0.30-0.39

≥0.40

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

  3. Regurgitant Fraction

    image

  4. Effective Regurgitant Orifice Area (EROA)

    image

  5. Proximal Isovelocity Surface Area

    image

Parameters for the Determination of the Severity of Mitral Stenosis2

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Indicator

Mild

Moderate

Severe

Mean pressure gradient (mm Hg)

<5

5-10

>10

Pressure half-time (ms)

90-150

150-219

>220

Mitral valve area (cm2)

>1.5

1.0-1.5

<1.0

Pulmonary artery pressure (mm Hg)

<30

30-50

>50

Mitral valve resistance (dyne.s.cm−5)

>85

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 ...

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