1. LV A B C D E F G H r E A Online Figure E2
A shows measurement of mitral regurgitation severity by measuring the neck of MR jet (vena contracta) in the parasternal long axis view. B and C show assessment of MR by MR jet area. Presence of proximal isovelocity acceleration (white arrow) in C with normal Nyquist limit (>60 cm/s) indicates severe MR. D shows calculation of MR effective regurgitant orifice area and regurgitant volume using flow acceleration (2π (r)2 x aliasing velocity/peak MR jet velocity) x time velocity integral of MR jet, where r is the radius of PISA). Vena contracta and MR jet area are measured using standard Nyquist limit (>60 cm/s) and proximal isovelocity surface acceleration is measured by decreasing Nyquist limit to 30 to 40 cm/s. E to H show Doppler measures of MR severity including MR jet density on CW Doppler (E), increased E wave height of >1.3 m/s (F), TTE image showing systolic blunting of pulmonary vein flow on PW Doppler (white arrow) (G) and TEE image with systolic reversal of pulmonary vein flow (white arrow) (H). E A