ECHOCARDIOGRAM ECHO FOR MITRIAL REGURGITATION Dr C S

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

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

Definition • Pathologic back flow of blood from the LV to the LA. •

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

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

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

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

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

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

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

Transoesophageal echo

Transoesophageal echo

TEE • Use of TEE – Pre op – Intra op • Indications •

TEE • Use of TEE – Pre op – Intra op • Indications • Limitations • Intra op – MR assessment – Assessment of repair

Monoplane transesophageal echocardiography LAA A 1 Ao P 1 A 2 P 2 A

Monoplane transesophageal echocardiography LAA A 1 Ao P 1 A 2 P 2 A 3 P 3

3 D transesophageal echocardiography

3 D transesophageal echocardiography

Anatomic echo parameters • • • LV dimension/size LA dilation LV volume Stroke volume

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

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

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

LA SIZE PARASTERNAL LONG AXIS RV RV AO LV IAS LAD LA LA w

LA SIZE PARASTERNAL LONG AXIS RV RV AO LV IAS LAD LA LA w

LV DIMENSIONS PARASTERNAL LONG AXIS RV IVS LV LVD NORMAL VALUES IVSd 6 -12

LV DIMENSIONS PARASTERNAL LONG AXIS RV IVS LV LVD NORMAL VALUES IVSd 6 -12 LVEDD 36 -52 LVPWd 6 -11 IVSs 6 -9 LVESD 24 -42 LVPWs 9 -14 LV EF 50 -75% LA LVPW

Colour flow doppler • Jet area index to LA • Vena contracta width RV

Colour flow doppler • Jet area index to LA • Vena contracta width RV RA LA

Central vs eccentric jet TRANSTHORACIC LV RV RA LA TRANSOESOPHAGEAL

Central vs eccentric jet TRANSTHORACIC LV RV RA LA TRANSOESOPHAGEAL

Pulmonary flow reversal RV RA

Pulmonary flow reversal RV RA

Spectral doppler

Spectral doppler

Etiologies of mitral regurgitation • Normal leaflet motion : - annular dilatation (LV dilatation,

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)

Various forms of mitral regurgitation Mitral prolapse in Barlow’s disease Rheumatic disease Mitral prolapse

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

Rheumatic RV LV LVOT LA

Rheumatic RV LV LVOT LA

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

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

Annular dilatation PARASTERNAL LONG AXIS APICAL 4 CHAMBER RV LV LA RA LA

Annular dilatation PARASTERNAL LONG AXIS APICAL 4 CHAMBER RV LV LA RA LA

MR severity

MR severity

Carpentier’s classification

Carpentier’s classification

Indications for surgery

Indications for surgery

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