Mitral regurgitation with aortic stenosis – Echocardiogram

Mitral regurgitation with aortic stenosis – Echocardiogram

Mitral regurgitation with aortic stenosis: Colour Doppler echocardiogram in parasternal long axis view showing jets of mitral regurgitation and aortic stenosis jets, both in systole. RV: right ventricle; LV: left ventricle; AV (arrow): domed stenosed aortic valve in systole; MV: closed mitral valve a systolic separation of leaflets causing mitral regurgitation; LA: left atrium; Ao: aorta; AS Jet: mosaic jet of aortic stenosis in the aorta, preceded by the flow acceleration in the left ventricular outflow tract. MR Jet: aliased mosaic jet of mitral regurgitation in the left atrium, starting from the closed mitral valve with a little systolic separation of the mitral leaflets. 

Quantification of mitral regurgitation by Colour Doppler echocardiogram

Semiquantitative grading of the degree of mitral regurgitation can by assessing the colour Doppler jet of mitral regurgitation in the left atrium. The measures considered are the distance to which the mitral regurgitant jet travels, the area of the mitral regurgitation jet and and ratio of the mitral regurgitation jet area to that of the left atrium. Miyatake K et al classified mitral regurgitation depending on the area of the mitral regurgitation jet as follows:¹

1. Grade 1 (Mild): Mitral regurgitation jet area less than 1.5 sq cm (+)
2. Grade 2 (Moderate): Mitral regurgitation jet area between 1.5 sq cm and 3.0 sq cm (++)
3. Grade 3 (Moderate – Severe): Mitral regurgitation jet area 3.0 and 4.5 sq cm (+++)
4. Grade 4 (Severe): Mitral regurgitation jet area more than 4.5 sq cm (++++)

Same group classified mitral regurgitation depending on the distance to which the mitral regurgitation jet is visible from the mitral valve to Grade 1 (less than 1.5 cm), Grade 2 (1.5-3.0 cm), Grade 3  (3.0-4.5 cm) and Grade 4 (more than 4.5 cm).

Mitral regurgitation jet to left atrial area ratio

Mitral regurgitation can be assessed semiquantitatively by comparing the ratio of the mitral regurgitation jet area to that of the left atrium.² There was good correlation between angiographically derived and Doppler derived severity assessments.

1. Grade I (Mild): Regurgitant jet area / left atrial area less than 20%
2. Grade II (Moderate): Regurgitant jet area / left atrial area between 20% and 40%
3. Grade III (Severe): Regurgitant jet area / left atrial area more than 40%

References

1. Miyatake K, Izumi S, Okamoto M, Kinoshita N, Asonuma H, Nakagawa H, Yamamoto K, Takamiya M, Sakakibara H, Nimura Y. Semiquantitative grading of severity of mitral regurgitation by real-time two-dimensional Doppler flow imaging technique. J Am Coll Cardiol. 1986 Jan;7(1):82-8.
2. Helmcke F, Nanda NC, Hsiung MC, Soto B, Adey CK, Goyal RG, Gatewood RP Jr. Color Doppler assessment of mitral regurgitation with orthogonal planes. Circulation. 1987 Jan;75(1):175-83.