Echocardiographic Criteria of Zoghbi et al for Grading Native Mitral Valve Regurgitation

Description

Zoghbi et al identified echocardiographic features associated with regurgitation of a native mitral valve. These were reported by a subcommittee and task force of the American Society of Echocardiography in Conjunction with the American College of Cardiology.

Parameters:

(1) central jet area in square cm

(2) central jet as percent of left atrial area (effective regurgitant orifice area or EROA)

(3) central jet characteristics

(4) vena contracta width in cm

(5) flow convergence

(6) systolic flow in pulmonary veins ( atrial fibrillation and left atrial filling pressure can blunt systolic flow)

(7) dominant wave in mitral inflow

(8) regurgitant volume in mL per beat

(9) regurgitant fraction in percent

(10) left ventricular size (used only in chronic lesions)

(11) Doppler continuous wave (CW) mitral regurgitant jet density and contour

(12) other findings

The first 5 items are considered the specific signs for regurgitant severity.

Parameter	Mild MVR	Moderate MVR	Severe MVR
central jet area	< 4 square cm	4 to 10	> 10 square cm
EROA	< 20%	20 to 39%	>= 40%
central jet	small		large; wall impinging and/or swirling in atrium
vena contracta width	< 0.3 cm	0.3 to 0.69	>= 0.7 cm
flow convergence	no or minimal	mild to moderate	large
systolic flow in pulmonary veins	forward flow, dominant		reversal
dominant wave	A-wave		E-wave
regurgitant volume in mL per beat	< 30 mL per beat	30 to 59 mL per beat	>= 60 mL per beat
regurgitant fraction in percent	< 30%	30 to 49%	>= 50%
left ventricular size	normal		dilated
left atrial size	normal		dilated
CW MR jet density	soft, faint		dense
CW MR jet contour	parabolic		triangular
other findings			ruptured papillary muscle; flail leaflet

where:

• Normal left ventricular minor axis is <= 2.8 cm per square meter BSA

• Normal left ventricular end-diastolic volume <= 82 mL per square meter BSA

• Normal left atrial anteroposterior diameter <= 2.8 cm per square meter BSA.

• Normal left atrial volume <= 36 mL per square meter BSA

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Description

Specialty

ICD-10