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Echocardiographic and Doppler criteria for severity of prosthetic mitral regurgitation using findings from transthoracic echocardiography and transesophageal echocardiography

Echocardiographic and Doppler criteria for severity of prosthetic mitral regurgitation using findings from transthoracic echocardiography and transesophageal echocardiography
Parameter Mild Moderate Severe
Structural parameters
LV size Normal* Normal or dilated Usually dilated
Prosthetic valveΔ Usually normal Abnormal◊ Abnormal◊
Doppler parameters
Color flow jet areaħ Small, central jet (usually <4 cm2 or <20% of LA area) Variable Large central jet (usually >8 cm2 or >40% of LA area) or variable size wall-impinging jet swirling in left atrium
Flow convergence¥ None or minimal Intermediate Large
Jet density: CW DopplerΔ Incomplete or faint Dense Dense
Jet contour: CW DopplerΔ Parabolic Usually parabolic Early peaking, triangular
Pulmonary venous flowΔ Systolic dominance‡ Systolic blunting‡ Systolic flow reversal†
Quantitative parameters**
VC widthΔ <0.3 cm 0.3 to 0.59 cm ≥0.6 cm
Regurgitant volume <30 mL/beat 30 to 59 mL/beat ≥60 mL/beat
Regurgitant fraction <30% 30 to 49% ≥50%
EROA <0.20 cm2 0.20 to 0.49 cm2 ≥0.50 cm2
CW: continuous wave; LV: left ventricular; LA: left atrial; VC: vena contracta; EROA: effective regurgitant orifice area; MR: mitral regurgitation; TEE: transesophageal echocardiography.
* LV size applied only to chronic lesions.
¶ In the absence of other etiologies of LV enlargement and acute MR.
Δ Parameter may be best evaluated or obtained with TEE, particularly in mechanical valves.
◊ Abnormal mechanical valves, for example, immobile occluder (valvular regurgitation), dehiscence or rocking (paravalvular regurgitation); abnormal biologic valves, for example, leaflet thickening or prolapse (valvular), dehiscence or rocking (paravalvlar regurgitation).
§ At a Nyquist limit of 50 to 60 cm/s.
¥ Minimal and large flow convergence defined as a flow convergence radius <0.4 and ≥0.9 cm for central jets, respectively, with a baseline shift at a Nyquist limit of 40 cm/s; cutoffs for eccentric jets may be higher.
‡ Unless other reasons for systolic blunting (eg, atrial fibrillation, elevated LA pressure).
† Pulmonary venous systolic flow reversal is specific but not sensitive for severe MR.
** These quantitative parameters are less well-validated than in native MR.
Reproduced from: Zoghbi WA, Chambers JB, Dumesnil JG, et. al. Recommendations for evaluation of prosthetic valves with echocardiography and Doppler ultrasound. J Am Soc Echocardiogr 2009; 22:975. Table used with the permission of Elsevier Inc. All rights reserved.
Graphic 119961 Version 1.0

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