The Mitral/Aortic Flow Velocity Integral Ratio in Mitral Regurgitation

Abstract

The development of echocardiography was driven, in part, by a need to diagnose mitral regurgitation in patients undergoing finger fracture commissurotomy in the 1950s. Decades later, color Doppler became the cornerstone for noninvasive evaluation of mitral regurgitation. The authors present 2 cases of calcific mitral stenosis in which reliance on color Doppler in transthoracic echocardiography resulted in erroneous conclusions as to the severity of coexisting mitral regurgitation. The possible application of the Mitral to Aortic Flow Velocity Integral Ratio in such cases as a possible adjunct to grading mitral regurgitation is also discussed.

Knowing the Limits: Pitfalls of Echocardiography in Mitral Regurgitation

“…4 Echo-reflective structures such as severe calcifications or prosthesis can make imaging with color Doppler challenging by masking the exact location for quantifiable measurements such as VCW and PISA. This is the proposed mechanism for the differences between preoperative TTE and intraoperative TEE findings described in the E-Challenge by Fox et al 2 For that reason it is recommended that patients with suboptimal acoustic windows during a TTE exam undergo a TEE or CMR. 1 Limitations to color Doppler are numerous and must be taken into account during exams to avoid errors.…”