Mitral regurgitation in PLAX and Apical 4C views

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Mitral regurgitation in PLAX and Apical 4C viewsMitral regurgitation

Parasternal long axis (PLAX) view showing mitral regurgitation (MR) jet into the left atrium. MR is seen as a bluish tongue shaped mosaic (multi colored) jet directed downwards into the left atrium, in the left panel. Aortic valve is seen as open and the mitral valve seen in closed position as it is a systolic frame. LV: Left ventricle; LA: Left atrium; IVS: Interventricular septum; RV: Right ventricle

Mitral regurgitationApical four chamber view on echocardiography showing a small bluish mosaic jet of MR into the left atrium across the closed mitral valve. This colour jet is consistent with a trivial MR as it occupies only a small portion of the left atrial area. Ideally one should sketch out the area of the left atrium and the MR jet to assess the ratio of the two and thereby the severity of mitral regurgitation. But practically this is seldom done in a busy echocardiography laboratory for a trivial MR as assessed visually (eyeballing!). Trivial MR can be taken as a normal finding with no practical significance.

Caution is needed while quantifying MR jet because the visible area can vary depending on the instrument settings and hemodynamic variables. Acute severe MR with hypotension can have very small jet area while hypertensive patients patients with mild MR can have large jet area [1]. That is why we always insist for a clinical evaluation prior to echocardiography, which will give a lot of valuable hints. The person with hypertension with mild MR will be clinically quite different from the person with acute severe MR and hypotension. Latter will most likely be in an intensive care unit, quite sick and unlikely to be brought to the echo room, rather we will be doing a bedside study!

Reference

  1. Grayburn PA, Weissman NJ, Zamorano JL. Quantitation of mitral regurgitation. Circulation. 2012 Oct 16;126(16):2005-17.