J Cardiovasc Ultrasound.  2015 Sep;23(3):121-133. 10.4250/jcu.2015.23.3.121.

Clinical Use of Doppler Echocardiography in Organic Mitral Regurgitation: From Diagnosis to Patients' Management

• Grigioni F
• Russo A
• Pasquale F
• Biagini E
• Barberini
• Ferlito M
• Leone O
• Rapezzi C

• KMID: 2068721
• DOI: http://doi.org/10.4250/jcu.2015.23.3.121

Abstract

Knowledge of mitral regurgitation (MR) is essential for any care provider, and not only for those directly involved in the management of cardiovascular diseases. This happens because MR is the most frequent valvular lesion in North America and the second most common form of valve disease requiring surgery in Europe. Furthermore, due to the ageing of the general population and the reduced mortality from acute cardiovascular events, the prevalence of MR is expected to increase further. Doppler echocardiography is essential both for the diagnosis and the clinical management of MR. In the present article, we sought to provide a practical step-by-step approach to help either performing a Doppler echocardiography or interpreting its findings in light of contemporary knowledge on organic (but not only) MR.

Keyword

Mitral regurgitation; Heart failure; Mitral repair; Echocardiography

MeSH Terms

Cardiovascular Diseases
Diagnosis*
Echocardiography
Echocardiography, Doppler*
Europe
Heart Failure
Mitral Valve Insufficiency*
Mortality
North America
Prevalence

Figure

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  Fig. 1 Parasternal long axis view by transthoracic echocardiography. Segmental analysis of the mitral valve. AV: aortic valve, LA: left atrium, LV: left ventricle, RV: right ventricle, VS: ventricular septum (see also Fig. 5).

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  Fig. 2 Parasternal short axis view by transthoracic echocardiography. Segmental analysis of the mitral valve. RV: right ventricle, VS: ventricular septum (see also Fig. 5).

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  Fig. 3 Four chambers apical view by transthoracic echocardiography. Segmental analysis of the mitral valve. LA: left atrium, LV: left ventricle, RA: right atrium, RV: right ventricle, VS: ventricular septum (see also Fig. 5).

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  Fig. 4 Two chambers apical view by transthoracic echocardiography. Segmental analysis of the mitral valve. LA: left atrium, LV: left ventricle (see also Fig. 5).

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  Fig. 5 Surgical view of the mitral valve (A). Spatial orientation of the most commonly used two-dimensional transthoracic echocardiographic views (B). Leaflet segmentation starts with A1-P1 close to the anterolateral commissure, A2-P2 centrally, and A3-P3 close to the posteromedial commissure.

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  Fig. 6 Three-dimensional trans-esophageal echocardiography facilitates evaluation of mitral valve leaflets. Cross-plane of the surgical view makes easier to measure the prolapse height of every segments. At the bottom in the figure, sagittal view of the valve at different levels. The annular plane is highlighted by the dotted line.

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  Fig. 7 Multiplanar reconstruction of mitral valve regurgitation using 3-dimensional (3-D) color Doppler full-volume acquisition by transesophageal echocardiography. Multiple simultaneous orthogonal 2-dimensional-like slices are presented in multiplanar reformatting mode, showing the long-axis cut planes (A and B) and the short-axis cut plane parallel to the mitral annulus (C). D: Reformatted 3-D volume illustrating the regurgitant jet. In panel C en face view of the vena contracta area with planimetry is feasible and can be measured (see the text for more explanations).

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  Fig. 8 A and B: Multiplane 2-dimensional transesophageal echocardiogram showing commissural view without (A) and with (B) color Doppler. A: From left to right three scallops of the mitral valve are evident postero-medial commissural scallop (arrow), middle segment of anterior leaflet (A2) and lateral segment of posterior leaflet (P1). B: Mitral regurgitation with eccentric jet from the postero-medial commisure direct toward the left appendage. C and D: Real time 3-dimensional (3-D) transesophageal echocardiography. C: Left atrial view ("en face" surgical view) in zoom 3-D acquisition of the mitral valve. The prolapse of posterio-medial commisural scallop is evident (arrow). D: 3-D transesophageal echocardiography reconstruction of the mitral valve using the mitral valve quantification software. A defect of mitral valve coaptation is present the level of the postero-medial commisure.

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