1. Echocardiographic Evaluation of Mitral Regurgitation Vincent Brinkman, MD Cardiovascular Medicine The Ohio State University

11. Echo Indications Indications for Transthoracic Echocardiography Class I 1. Transthoracic echocardiography is indicated for baseline evaluation of LV size and function, RV and left atrial size, pulmonary artery pressure, and severity of MR in any patient suspected of having MR. (Level C) 2. Transthoracic echocardiography is indicated for delineation of the mechanism of MR. (Level B) 3. Transthoracic echocardiography is indicated for annual or semiannual surveillance of LV function (estimated by ejection fraction and end systolic dimension) in asymptomatic patients with moderate to severe MR. (Level C) 4. Transthoracic echocardiography is indicated in patients with MR to evaluate the MV apparatus and LV function after a change in signs or symptoms. (Level C) 5. Transthoracic echocardiography is indicated to evaluate LV size and function and MV hemodynamics in the initial evaluation after MV replacement or MV repair. (Level C) Class IIa Exercise Doppler echocardiography is reasonable in asymptomatic patients with severe MR to assess exercise tolerance and the effects of exercise on pulmonary artery pressure and MR severity. (Level C) Class III Transthoracic echocardiography is not indicated for routine follow-up evaluation of asymptomatic patients with mild MR and normal LV size and systolic function. (Level C)

12. Follow up Echo Indications Otto C. M. Evaluation and Management of Chronic Mitral Regurgitation N Engl J Med 2001; 345:740-746, Sep 6, 2001.

26. PISA Method <0.2cm 2 = mild 0.2-0.29cm 2 = mod >0.4cm 2 = severe

27. Or . . . Assuming the MR velocity is around 5 m/s (pressure difference of 100 mmHg) and the aliasing velocity is set at 40 cm/s. Pu et al., J Am Soc Echocardiogr. 2001; 14:180.

30. Estimating Regurgitant Volume and ROA

31. Regurgitant Volume Regurgitant Volume Regurgitant Fraction

35. Integrated approach to MR grading MR Color Flow imaging Vena Contracta Jet Direction Severe MR PISA RV and ROA Pulse Doppler RV and ROA Mild MR From Otto, Textbook of Clinical Echocardiography. Elsevier Inc.2004 Appears to be mild >0.7cm <0.3cm Central Eccentric Central Jet No PISA seen Jet Area < 4.0 cm2 Or <20% LA area CWD not intense

36. Mitral Regurgitation Index

37. Mitral Regurgitation Index

38. ROA and Outcomes

42. MR ECHO Paramters From: American Society of Echocardiography, Recommendations for Evaluation of the Severity of Native Valvular Regurgitation with Two-dimensional and Doppler Echocardiography. 2003.

43. MR ECHO Paramters From: American Society of Echocardiography, Recommendations for Evaluation of the Severity of Native Valvular Regurgitation with Two-dimensional and Doppler Echocardiography. 2003.

44. Paramater advantages and disadvantages