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Written by Andrea Fields MHA, RDCS

Mitral Regurgitation Case Study Demonstration!

Our blog last week discussed the algorithm for determining the severity of chronic mitral regurgitation, provided by the ASE! If you missed it, you can find it here! Let’s use this information and work through a case study together!

Patient History

A 50 year old male admitted to hospital for shortness of breath and palpitations. EKG showed paced sinus rhythm. BSA is 2.0 m² and blood pressure (BP) is 123/70. The patient has the following history:

  • Pacemaker
  • Congestive Heart Failure
  • Pulmonary Hypertension
  • Diabetic

Parasternal Long Axis (PLAX):

Vena Contracta Width:

 Apical 4 (AP4):

Mitral Valve Inflow:

Pulmonary Vein Flow:

Color Jet Area:

PISA Radius:

MR CW Doppler Jet:

Apical 2 & 3 (AP2/AP3):

Measurements:

  • End-Diastolic Volume (EDV) Indexed: 94 mL/m²
  • Ejection Fraction (EF): 45%
  • LA Volume Indexed: 70 mL/m²
  • Vena Contracta Width: 0.6 cm
  • MV Inflow E-Wave: 1.5 m/s
  • PISA Radius (Flow Convergence): 1.1 cm
  • Aliasing Velocity: 34 cm/sec
  • MR VTI: 5.5 m/s & 163 cm

Chronic MR Algorithm Chart:

Step 1: Can we rule out MILD or SEVERE? Do the findings meet 4 or more (>4) of the criteria?

Step 2: Perform Quantitative Methods (PISA Method)

Step 3: Which grade do the values fall under?

Step 4: Determine severity!

Conclusion:

We hope you enjoyed our mitral regurgitation series! We will continue to breakdown ASE new guideline papers!

Andrea Fields MHA, RDCS

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References: 

Zoghbi, W. A., MD, FASE, & Adams, D., RCS, RDCS, FASE. (2017). Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation. JASE, 30, 4th ser., 1-69. Retrieved June 12, 2017.

adult echoASE guidelinescardiac chamber quantificationcase studyMitral LeafletsMitral RegurgitationMitral ValveMRPISA

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LET US KNOW WHAT YOU THINK...

Nilda Espinola-Zaval
Very detailed assessment of mitral regurgitation. I enjoyed it.
OSAMA ELKADI
what is PKV reg?, what is the differene between the previous method of calculation of rvol and this method using pkv. thanks.
Cardioserv
"PKV Reg" is the peak velocity of regurgitant flow by CW Doppler. This case study demonstration uses the PISA (flow convergence) method to determine the severity of mitral regurgitation. PISA method provides us with both EROA & RVol.
Hajar
Thanks for the illuminating Blog. I have one question concerning the PISA radius measurement, you seem to take it always VERTICALLY, can we also measure it from the center of the hemisphere towards the first aliasing RADIALLY,or is it the same?
Liwaa
Thank you for this interesting application
Adolfo Sciartilli
I have two questions for you. #1 How does aortic valve regurgitation affect mitral valve regurgitation quantification? #2 What is the literature reference for the algorithm that you showed?
Chalabi
Great simplified information , thank you

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