Mitral Regurgitation Flashcards
What are the causes of MITRAL REGURGITATION?
- mitral annular dilatation
- mitral annulus calcification (MAC)
- myxomatous
- rheumatic
- endocarditis
- marfan’s disease
- congenital cleft MVL
- infiltrative disease distorts leaflets
- auto immune like rheumatoid and lupus
- age related degenerative changes to leaflets
- abnormal leaflet motion due to hypertrophic cardiomyopathy
- ischemic MR
- MR due to LVE
What can cause MITRAL ANNULAR DILATATION?
LAE or LVE
What is the process of MYXOMATOUS
connective tissue disorder where leaflets thicken, elongate and redundant
When does a FLAIL LEAFLET occur?
when a leaflet or chord tears or ruptures
What do we witness in RHEUMATIC HEART DISEASE?
we witness commissural fusion, leaflet tip thickening, & chordal shortening/fusion
What echo findings do we see with MARFANS DISEASE?
- redundant AML & dilation of AR
- redundant AML sags into LA in systole
How does LVE lead to MR?
MV annulus is pulled apart and as the LV enlarges, the papillary muscle reorients to best contribute to coaptation of leaflets
What does Functional or Secondary MR mean?
when a condition other than abnormal leaflets/chord lead to MR - LVE, LAE, HCm, ischemia
How does ischemia lead to MR?
Lack of oxygen to the papillary muscle inhibits its contraction and extension of the chordae to push the leaflets to closed position
What is the earliest symptom of CHRONIC MR?
fatigue
What symptom is seen in ACUTE MR?
sudden pulmonary edema (fluid in lungs)
What are SIGNS OF MR?
- inadequate cardiac output
- pulmonary vascular overload
- peripheral edema - overload to right
- palpitations
What AUSCULATIONS are heard with MR?
- blowing high pitched holosystolic murmur at apex
- S3 (ventricular gallop)
In what situations would a MV REPLACEMENT/REPAIR be done?
1.symptomatic MR
2. valves in need of obvious abnormality apparatus
3. asymptomatic MR before LVIDs >/= 4cm
4. asymptomatic MR before EF/FS falls below normal
How is a VALVULOPLASTY done surgically?
resecting a prolapsing scallop or replacing broken chordae
How is a VALVULOPLASTY done with CATHETER?
A mitral valve clip is advanced and deployed into the LV, clipping both leaflets together. This limits the degree of prolapse on closure in systole.
How is an ANNULOPLASTY done?
An annular ring is sewn into the annulus to tighten it to reduce the degree of MR
Anterior directed jet is abnormality of?
PML
Posterior directed jet is abnormality of?
AML or papillary muscle
Centrally directed jet is abnormality of?
dilated LV or annulus
What are the PRIMARY MR FINDINGS?
- Jet of MR
- LV Volume overload pattern
- abnormality in mitral apparatus
- LAE
What are the SECONDARY MR FINDINGS?
- systolic bowing of IAS towards RA
- decreased IVRT due to increased LAP
- RVH/PSM/D Shaped LV
Name the 2D MR findings
- Jet of MR
- LV volume overload pattern
- Abnormality in mitral apparatus
- LAE
- Systolic bowing of IAS towards RA in 2D A4
6.RVH/ “D shaped” LV
Name the M MODE MR findings
- LV volume overload pattern
- LAE: increased motion of AR due to exaggerated LA filling and emptying
Name the 2D FINDINGS FOR MVP
- benchmark
- leaflets demonstrate a distinct buckle back motion
- thickened redundant leaflets & chordae
What does “benchmark” look like?
movement of any part of the anterior or posterior MV leaflets past the annular place
In what views can you witness “benchmark”
PLAX and A3 only
Name the M MODE FINDINGS OF MVP
- thick redundant leaflets
- evidence of one or both leaflets prolapsing in mid - late systole
- evidence of one or both leaflets prolapsing throughout systole
- flail posterior MV leaflet
- false MVP - multiple echo artifact
What 2D/M MODE finding do you see with MAC?
isolated area of calcification
How does MAC appear at PLAX?
appears as an echogenic nodule
How does MAC appear at PSAX?
Appears as echogenic hemi elliptical line
How does MAC appear at M MODE?
Appears as a echogenic hemi elliptical line
Small echogenic nodule in PLAX = ____ echogenic line in PSAX and M Mode
thin
Large echogenic nodule in PLAX = ____ echogenic line in PSAX and M MODE
thick
