Grading the severity of organic mitral regurgitation
| Parameters | Mild | Moderate | Severe |
| QUALITATIVE | |||
| Mitral valve morphology | Normal/Abnormal | Normal/Abnormal | Flail lefleat/ruptured PMs |
| Colour flow MR jet | Small, central | Intermediate | Very large central jet or eccentric jet adhering, swirling and reaching the posterior wall of the LA |
| Flow convergence zone | No or small | Intermediate | Large |
| CW signal of MR jet | Faint/Parabolic | Dense/Parabolic |
Dense/Triangular |
| SEMI-QUANTITATIVE | |||
| VC width (mm) | <3 | Intermediate | ≥7 (>8 for biplane) |
| Pulmonary vein flow | Systolic dominance | Systolic blunting | Systolic flow reversal |
| Mitral inflow | A wave dominant | Variable | E wave dominant (>1.5 cm/s) |
| TVI mit /TVI Ao | <1 | Intermediate | >1.4 |
| QUANTITATIVE | |||
| EROA (mm²) | <20 | 20-29; 30-39 | ≥40 |
| R vol (mL) | <30 | 30-44; 45-59 | ≥60 |
| +LV and LA size and the systolic pulmonary pressure |
Assessment of severety of mitral regurgitation
|
SPECIFIC SIGNS OF SEVERITY
|
Mild | Severe | ||
| Jet (Nyquist 50-60 cm/sec) | <4 cm² or 20% LA; small & central | >40% LA; large & central or wall impinging & swirling | ||
| Vena contracta | <0.3 cm | >0.7 cm | ||
| PISA r (Nyquist 40 cm/sec) | None/minimal (<0.4 cm) | Large (>1 cm) | ||
| Pulmonary vein flow | --- | Systolic reversal | ||
| Valve structure | --- | Flail or rupture | ||
|
SUPPORTIVE SIGNS OF SEVERITY
|
Mild |
Severe |
||
| Pulmonary vein flow | Systolic dominant | |||
| Mitral inflow | A-wave dominant | E-wave dominant (>1.2 m/sec) | ||
| CW trace | Soft & parabolic | Dense & triangular | ||
| LV & LA | Normal size LV if chronic MR | Enlarged LV & LA if no other cause |
Report as MODERATE if signs of regurgitation are greater than MILD but there are no signs of SEVERE regurgitation.
