1. ECHOCARDIOGRAM (ECHO) FOR MITRIAL REGURGITATION
Dr C.S Mahlangu
University of Limpopo(medunsa)
Cardiothoracic registrar

2. Definition Pathologic back flow of blood from the LV to the LA.
Problem of leaflets,anulus or subvulvular apparatus

3. Modalities TEE 3D ECHO TTE 2D ECHO M-MODE COLOUR DOPPLER Continuous
pulse
Tissue doppler imaging

4. Transthoracic echo PARASTERNAL LONG AXIS PARASTERNAL LONG AXIS
APICAL FOUR CHAMBER
APICAL FOUR CHAMBER
APICAL FOUR CHAMBER LV RV RA LA

5. SHORT AXIS LV AT PAPPILARY LEVEL
Transthoracic echo
SHORT AXIS LV AT PAPPILARY LEVEL RV RV
IVS
IVS AL
LVD PM
LVPW
LVPW

6. Transoesophageal echo

7. TEE Use of TEE Indications Limitations Pre op Intra op MR assessment
Assessment of repair

8. Monoplane transesophageal echocardiographyAo A1 A2 A3 P1 P2 P3
LAA

9. 3D transesophageal echocardiography

10. Anatomic echo parameters
LV dimension/size
LA dilation
LV volume
Stroke volume
Valve abnormality

11. LA SIZE
APICAL 4 CHAMBER LV RV RA LA
Normal size = 19-40mm

12. LA SIZE
PARASTERNAL LONG AXIS RV RV AO LV
IAS
LAD LA
LA wall

13. LV DIMENSIONS PARASTERNAL LONG AXIS RV IVS LV LVD LA LVPW
NORMAL VALUES
IVSd
LVEDD
LVPWd 6-11
IVSs 6-9
LVESD 24-42
LVPWs 9-14
LV EF 50-75%
LVPW

14. Colour flow doppler Jet area Jet area index to LA Vena contracta widthRV LA RA

15. Central vs eccentric jet
TRANSTHORACIC
TRANSOESOPHAGEAL LV RV RA LA

16. Pulmonary flow reversalRV RA

17. Spectral doppler

18. Etiologies of mitral regurgitation
Normal leaflet motion :
annular dilatation (LV dilatation, ischemia)
leaflet perforation (trauma, endocarditis, ostium primum ASD)
Excess leaflet motion :
mitral valve prolapse (Barlow’s disease, Marfan syndrom, Ehler-Danlos syndrom, pseudoxanthoma elasticum)
chordae rupture (prolapse, trauma, endocarditis)
papillary muscle rupture (infarction, trauma)
Restricted leaflet motion :
leaflet retraction (rheumatic fever, carcinoïd heart diasease, systemic lupus, annular calcifications, ...)
systolic anterior motion (HCOM)
chordae retraction (rheumatic disease)
papillary muscle retraction and/or dysfunction (aneurysm, infarction, ischemia, endomyocardial fibrosis)

19. Various forms of mitral regurgitation
Mitral prolapse in
Barlow’s disease
Mitral prolapse with
ruptured chords
Rheumatic
disease
Infective endocarditis

20. Rheumatic RV
LVOT LV LA

21. Prolapse and flail leaflet
MYXOMATOUS
BARLOW’S DISEASE
ISCHEMIC
TRAUMA
ENDOCARDITIS

22. Annular dilatation PARASTERNAL LONG AXIS APICAL 4 CHAMBER RV LV LV LV

23. MR severity

24. Carpentier’s classification

25. Indications for surgery