Mitral Regurgitation 2D Echocardiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Aetiology and morphological features in 2-D Echocardiography

Rheumatic Mitral regurgitation

In rheumatic mitral regurgitation, there is some degree of commissural fusion and thickening of the tips visible in 2 dimensional echocardiography. The movement of the valve leaflets is restricted.

Myxomatous mitral valve

The leaflets and chordae are thick and reduntant. Reduced tensile strength leads to progressive elongation or rupture of chordae. Ruptured chordae appear as flail segments. To diagnose mitral valve prolapse, the following criteria should be fulfilled during echocardiography - Movement of any part of either leaflet more than 2mm behind the annular plane in parasternal long axis view and movement of point of co-aptation behind the annular plane in apical 4 chamber view.

Annular calcification

Mitral annulus is usually smaller in systole. The increased rigidity due to annular calcification impairs contraction. In 2D- echocardiography, there is increased echogenicity on the LV side immediately adjacent to the attachment of the posterior mitral valve leaflet. Region of anterior mitral leaflet is only rarely involved. This is common in elderly subjects and younger ones with chronic renal failure and hypertension.

Ischaemic mitral regurgitation

Mitral regurgitation can occur in ischemia as a result of regional left ventricular dysfunction with abnormal contraction of papillary muscle or underlying ventricular wall. Myocardial infarction can result in MR at rest while if the underlying cause is ischemia the MR may be intermittent. The echocardiogram is characterized by restricted valve leaflet motion and tenting of mitral valve in systole.

Papillary muscle rupture

This is usually a complication of myocardial infarction. If entire papillary muscle is disconnected from the left ventricle severe MR results and few survive. Partial rupture is more common.

Functional mitral regurgitation

Functional MR results due to LV dilatation and systolic dysfunction in those with a structurally normal mitral valve apparatus.