Mitral Flow Doppler
Mitral flow is assessed by placing the Doppler cursor just distal to the mitral valve in apical four chamber view. Two diastolic waves, E and A are seen in normal mitral Doppler. The E wave is early diastolic and A wave occurs during atrial systole. A wave is absent in atrial fibrillation. Normally E wave is taller than A wave. A wave becomes prominent in diastolic dysfunction of the left ventricle. This leads to E/A reversal. E/A reversal is the most commonly used index of left ventricular diastolic dysfunction during routine echocardiography, though it has several limitations.
In restrictive filling pattern of the left ventricle, E wave is tall, more than 1.5 times the A wave. This is also a pattern of diastolic dysfunction of the left ventricle. The E wave in this case has a fast deceleration slope. E waves can be tall in the presence of severe mitral regurgitation .
Sometimes a third wave known as L wave  may be seen between the E and A waves in mitral Doppler. Third wave is also sometimes called as T wave. Read more on triphasic left ventricular filling pattern…
- Beaudoin J, Levine RA, Yosefy C, Beeri R, Neary JH, Morgan NV, Passeri JJ. Severe ischemic mitral regurgitation despite normally contracting subpapillary myocardium. Circulation. 2012; 126: 138-141.
- Kumar V, Jose J, Jose VJ. L wave in echo Doppler. Indian Heart J. 2014 May-Jun;66(3):392-3.