Mitral Flow Doppler

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 [1].

Sometimes a third wave known as L wave [2] 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…

References

  1. 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.
  2. Kumar V, Jose J, Jose VJ. L wave in echo Doppler. Indian Heart J. 2014 May-Jun;66(3):392-3.

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