Characterization of Primary Mitral Regurgitation With Flail Leaflet and/or Wall-Impinging Flow

Comparison of Mitral Regurgitant Volume Assessment between Proximal Flow Convergence and Volumetric Methods in Patients with Significant Primary Mitral Regurgitation: An Echocardiographic and Cardiac Magnetic Resonance Imaging Study

“…Very recently, the same group reported a prevalence of only 46% of patients with flail leaflet classified as severe MR by CMR according to CMR-derived RVol ($60 mL). 39 In our study population, using the 60 mL RVol threshold would result in a reclassification of one-third of patients from ''severe'' MR using PISA-RVol to ''moderate'' MR using CMR-RVol or TTE-RVol. However, the 60 mL threshold was first calibrated by comparing echocardiographic RVol (PISA and/or TTE volumetric method pooled together) to LV angiographic grading (four grades) as the reference standard.…”

Role of Cardiovascular Magnetic Resonance in Native Valvular Regurgitation: A Comprehensive Review of Protocols, Grading of Severity, and Prediction of Valve Surgery

“…MRvol values truly differ among volumetric methods and the PISA method. There is a consistent tendency to obtain higher MRvol values by PISA relative to CMR (40)(41)(42), resulting in higher MR severity assessment with a risk of undergoing surgery without severe MR by CMR (20). The discrepancy between these two modalities is more pronounced in patients with late systolic or multiple jets than central and holosystolic jet (38).…”

Multimodality Imaging in Valvular Structural Interventions

“…48 Cine imaging also allows measurement of LV volumes, LV stroke volume and EF by segmenting a base-to-apex stack of cine images in end-diastole and end-systole, and applying Simpson's method, which is independent of any assumption related to chamber geometry. 49 A similar approach can be used to measure left atrial volume and function. Cine imaging is complemented by phase-contrast, velocity-encoded imaging, which serves to enhance visualisation of the regurgitant lesion when acquired along the direction of the jet (in plane) or to quantify flow through the ascending aorta when images are taken perpendicular to the vessel (through plane).…”

“…48 However, the presence of a flail leaflet and Coandă effect on TTE in patients with primary MR has been associated with greater RV mitral and RF mitral . 49 Besides this indirect method, techniques directly gauging the regurgitant volume have also been implemented, including signal void, the size of the regurgitant jet and the regurgitant orifice area. 50…”

“…Cine imaging also allows measurement of LV volumes, LV stroke volume and EF by segmenting a base-to-apex stack of cine images in end-diastole and end-systole, and applying Simpson’s method, which is independent of any assumption related to chamber geometry. [ 49 ]…”