Table 4.9 Summary: Echocardiographic features of mitral regurgitation

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Aims of echocardiographic examination

Use 2DE to evaluate valvular structure:

gain subjective impression of volume overload

measure left atrial dimension

Use M-mode to measure left ventricular diameter at end-diastole and end-systole Use pulsed-wave Doppler to detect and map area of jet

Technique

Right parasternal long-axis view for overall assessment of cardiac function

Right parasternal short-axis view for positioning of cursor for measurement of LVD

Right and left parasternal views for assessment of left atrial structure and motion

Left parasternal long-axis view for measurement of left atrial diameter

Tilted left parasternal long-axis view for pulsed-wave Doppler mapping

Common findings

Mild/no gross valvular abnormalities

Degrees of:

increased LVDd due to volume overload increased left atrial dilation due to volume overload increased fractional shortening due to regurgitant fraction regurgitant flow detected on pulsed-wave Doppler mapping

Other significant findings

Diffuse or localised valvular thickening

Valve prolapse

Flail leaflet

Arrhythmias

Other cardiac disease

Good prognostic indicators

No volume overload

No gross valvular abnormalities

Limited area of regurgitant flow detected on pulsed-wave Doppler mapping

Poor prognostic indicators

Marked volume overload (LVDd>14.5 cm, LAD>15.5 cm)

Exaggerated VS motion

Moderate diffuse or localised valvular thickening

Flail leaflet

Vegetative lesions of endocarditis

Dilated pulmonary artery

Large area of jet of regurgitant blood detected on pulsed-wave Doppler mapping

Pathological arrhythmias