Assessment of mitral regurgitation

Echo-Doppler is an extremely effective tool both for determining the pathology responsible for MR and for making an assessment of its severity. In the majority of patients, an "eyeball" grading of severity on a range from mild to severe is generally sufficient for clinical purposes. More formal quantitative approaches may be required in cases where there is discrepancy between this eyeball assessment and other clinical findings, and all cardiac sonographers should be conversant with at least one of these techniques. Exercise echocardiography may be required to assess the degree of regurgitation during the haemodynamic conditions occurring at the time of the patient's symptoms. Exercise or pharmacological stress echocardiography may be also required in those patients with MR related to dynamic myocardial ischaemia. Serial measurement of left ventricular dimensions and pulmonary artery pressure is vitally important to detect impending problems with left ventricular dysfunction or pulmonary hypertension. Finally, as mitral valve repair becomes a safer procedure contemplated for asymptomatic patients, serial monitoring of EROA may also become advantageous to aid the decision of timing of valve surgery.