Mitral regurgitation ventriculogram

Intern Survival Guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Echocardiography is the primary imaging modality that is used to diagnose and serially evaluate mitral regurgitation, but the ventriculogram can also be used to quantitate the magnitude of mitral regurgitation.

Left Ventriculographic Evaluation of Mitral Regurgitation

Both the RAO and LAO/Cranial projections can be used to identify significant mitral regurgitation. Grading the amount of regurgitation is based on the amount of opacification of the left atrium compared to the left ventricle, the atrial size and the number of cycles required for maximal opacification of the left atriun. Elevation of left atrial pressure in acute regurgitation and dilation of the left atrium from chronic regurgitation can both interfere with the use of this grading system.

1+ Mitral Regurgitation

There is brief and incomplete atrial opacification over several cycles. The dye clears rapidly. There is no atrial enlargement.

1+ MR

1+ MR LAO with SAM

2+ Mitral Regurgitation

There is moderate opacification of the atria with each cycle. The opacification is never greater than LV opacification. There is no significant LA enlargement.

2+ MR

3+ Mitral Regurgitation

There is atrial opacification equal to ventricular opacification. There is delayed clearing of atria over several cycles. There is significant enlargement of the left atrium.

3-4+ MR

3+ MR

4+ Mitral Regurgitation

There is left atrial opacification which is immediate and is greater than that of the left ventricle. There is severe enlagement of the left atrium. There is opacification of the pulmonary veins.

4+ Paravalvular MR

4+ MR