Regurgitation

Question 1

List Carpentier Class for mitral regurgitation.

Answer 1

I – Normal leaflet motion (Etiology annular dilation or leaflet perforation)
II – Increased leaflet motion (Etiology chordal elongation, rupture, papillary elongation, rupture)
IIIa – Restricted leaflet motion in BOTH diastole and systole
IIIb – Restricted leaflet motion in systole ONLY

Question 2

How does mitral inflow (PW) differ between mild and severe MR?

Answer 2

Mild – A wave dominant
Moderate – Variable
Severe – E wave dominant

Question 3

How does pulmonary vein flow differ between mild and severe MR?

Answer 3

Mild – Systolic dominance
Moderate – Systolic blunting
Severe – Systolic flow reversal
** Unless other reasons for systolic blunting (e.g. AFib, elevated LA pressure)

Question 4

How does jet contour (CW) differ between mild and severe MR?

Answer 4

Mild – parabolic
Moderate – usually parabolic
Severe – early peaking - triangular

Question 5

What is the vena contracta width (cm) for mild and severe MR?

Answer 5

Mild < 0.3

Severe >0.69

Question 6

What is the EROA (cm2) for mild and severe MR?

Answer 6

Mild < 0.2

Severe > 0.39

Question 7

What are specific signs of severity for MILD MR? Also list supportive signs.

Answer 7

1. Small central jet < 4cm2 or < 0.3cm
2. No or minimal flow convergence

• Systolic dominant flow in pulmonary vein
• A wave dominant mitral inflow
• Soft density, parabolic CW doppler MR signal
• Normal LV size

Question 8

What are specific signs of severity for SEVERE MR? Also list supportive signs.

Answer 8

1. VC width >0.69cm with large central MR jet (area > 40% of LA) or with a wall-impinging jet of any size, swirling in LA
2. Large flow convergence
3. Systolic reversal in pulmonary veins
4. Prominent flail MV leaflet or ruptured papillary muscle

• Dense, triangular CW doppler MR jet
• E-wave dominant mitral inflow
• Enlarged LA and LV size (in chronic MR)