Valve Hemodynamics
a
Associated
Cardiac Findings Symptoms
• No MR jet or small central jet
area <20% LA on Doppler
• Small vena contracta <0.30 cm
• Normal or mildly
dilated LV with fixed
(infarction) or inducible
(ischemia) regional wall
motion abnormalities
• Primary myocardial
disease with LV dilation
and systolic dysfunction
Symptoms due to
coronary ischemia or
HF may be present
that respond to
revascularization and
appropriate medical
therapy
• ERO <0.20 cm
2 b
• RVol <30 mL
• RF <50%
• Regional wall motion
abnormalities with
reduced LV systolic
function
• LV dilation and systolic
dysfunction due to
primary myocardial
disease
Symptoms due to
coronary ischemia or
HF may be present
that respond to
revascularization and
appropriate medical
therapy
• ERO ≥0.20 cm
2 b
• RVol ≥30 mL
• RF ≥50%
• Regional wall motion
abnormalities with
reduced LV systolic
function
• LV dilation and systolic
dysfunction due to
primary myocardial
disease
Symptoms due to
coronary ischemia or
HF may be present
that respond to
revascularization and
appropriate medical
therapy
• ERO ≥0.20 cm
2 b
• RVol ≥30 mL
• RF ≥50%
• Regional wall motion
abnormalities with
reduced LV systolic
function
• LV dilation and systolic
dysfunction due to
primary myocardial
disease
• HF symptoms
due to MR
persist even after
revascularization
and optimization
of medical therapy
• 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.
b
e measurement of the proximal isovelocity surface area by 2D TTE in patients with chronic
secondary MR underestimates the true ERO due to the crescent shape of the proximal convergence.
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