Quantification of multiple mitral regurgitation jets

Quantification of multiple mitral regurgitation jets

Multiple mitral regurgitation jets can occur when there are multiple areas of prolapse as in Barlow’s disease. In this case multiple methods are available for assessment of total mitral regurgitation due to the several jets. PISA (proximal isovelocity surface area) method can be used to calculate the effective regurgitant orifice (ERO) and regurgitant volume of each jet and these can be summed up to get the total effective regurgitant orifice and total regurgitant volume.

Total mitral regurgitation can also be calculated as the difference between the mitral and aortic flow per beat. This is applicable only when there is no significant aortic regurgitation. Doppler technique is used to find the velocity time integral across the mitral and aortic valves and dimensions used to estimate the flow. This is quantitative Doppler method of assessing total mitral regurgitation.

Yet another method of quantitation is to estimate end diastolic and end systolic volumes by the Simpson’s area length method on two dimensional echocardiography. The difference will be the sum of forward stroke volume plus regurgitant volume. Subtracting the stroke volume from this will give the regurgitant volume. This can be considered as a quantitative two dimensional method of estimating total mitral regurgitation.