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Functional Assessment of Mitral Regurgitation by Transthoracic Echocardiography Using Standardized Imaging Planes

Diagnostic Accuracy and Outcome Implications

Jean-Luc Monin, MD^_*,_*, Patrick Dehant, MD, Cécile Roiron, MD^_*, Mehran Monchi, MD, Jean-Yves Tabet, MD^_*, Philippe Clerc, MD, Guy Fernandez, MD, Rémi Houel, MD, Jérome Garot, MD, PhD^_*, Christophe Chauvel, MD and Pascal Gueret, MD, FACC^_*

^_* Departments of Cardiology and Cardiac Surgery, Henri Mondor Hospital, Créteil, France (Assistance Publique Hôpitaux de Paris)
Departments of Cardiology and Cardiac Surgery, Clinique Saint-Augustin, Bordeaux, France
Department of Intensive Care Medicine and Cardiac Surgery, Institut Hospitalier Jacques Cartier, Massy, France

View larger version (47K): [in a new window]   Figure 1 Four imaging planes to assess the precise localization of prolapsed or flail segments. (A) Intercommissural plane assessing the continuity of the commissural areas. (B) Parasternal short-axis view showing the anterior leaflet (A1, A2, and A3) and the three scallops of the posterior leaflet (P1, P2, and P3). (C) Parasternal long-axis view showing the middle segments of anterior (A2) and posterior (P2) leaflets. (D) Apical four-chamber view showing the anterior para commissural zone (between P1 and P2). ANT. = anterior; AO = descending aorta; AV = aortic valve; LA = left atrium; LAA = left atrial appendage; LV = left ventricle; POST. = posterior; PV = pulmonary vein; RV = right ventricle; TV = tricuspid valve.

View larger version (85K): [in a new window]   Figure 2 Flail posterior middle scallop (P2). A Parasternal long-axis view showing the flail P2 segment (arrow); (B) and (C) Parasternal short-axis and inter-commissural views, respectively, showing medial doming of flail P2 scallop (arrows) without lateral discontinuity in the commissural areas (P1 and P3).

View larger version (115K): [in a new window]   Figure 3 Posterior commissural prolapse. Eccentric regurgitant jet (A) resulting from a commissural discontinuity (arrows) seen in the intercommissural plane (B) and parasternal short-axis view (C).

View larger version (11K): [in a new window]   Figure 4 Kaplan-Meier survival curves according to the localization of prolapsed or flail segments in patients with degenerative mitral regurgitation.