25
Valve Hemodynamics
a
Hemodynamic
Consequences Symptoms
• No MR jet or small central jet area
<20% LA on Doppler
• Small vena contracta <0.3 cm
None None
• Central jet MR 20%–40% LA or
late systolic eccentric jet MR
• Vena contracta <0.7 cm
• RVol <60 mL
• RF <50%
• ERO <0.40 cm
2
• Angiographic grade 1+–2+
• Mild LA enlargement
• No LV enlargement
• Normal pulmonary
pressure
None
• Central jet MR >40% LA or
holosystolic eccentric jet MR
• Vena contracta ≥0.7 cm
• RVol ≥60 mL
• RF ≥50%
• ERO ≥0.40 cm
2
• Angiographic grade 3+–4+
• Moderate or severe LA
enlargement
• LV enlargement
• PHTN may be present at
rest or with exercise
• C1: LVEF >60% and
LVESD <40 mm
• C2: LVEF ≤60% and
LVESD ≥40 mm
None
• Central jet MR >40% LA or
holosystolic eccentric jet MR
• Vena contracta ≥0.7 cm
• RVol ≥60 mL
• RF ≥50%
• ERO ≥0.40 cm
2
• Angiographic grade 3+–4+
• Moderate or severe LA
enlargement
• LV enlargement
• PHTN present
• Decreased
exercise
tolerance
• Exertional
dyspnea
a
Several valve hemodynamic criteria are provided for assessment of MR severity, but not all criteria
for each category will be present in each patient. Categorization of MR severity as mild, moderate,
or severe depends on data quality and integration of these parameters in conjunction with other
clinical evidence.
