Cardiology>>>>>Valvular heart disease and Endocarditis
Question 2#

You are asked to review the echocardiogram of a 74-year-old woman with a loud pansystolic murmur. (following pic)

The following statements are all true, except:

A) The jet of regurgitation is anteriorly directed
B) The regurgitation is likely to be chronic
C) Using PISA to assess the severity of the regurgitant jet is more accurate than measuring the vena contracta
D) The MV inflow E-wave velocity is 1.6 m/s; this suggests severe MR
E) Systolic pulmonary vein flow reversal is not a sensitive measure of severe MR

Correct Answer is C

Comment:

The video shows prolapse of the posterior mitral valve leaflet. There is eccentric MR.The vena contracta (VC) can be measured in both central and eccentric jets to estimate the severity of MR. The VC should ideally be measured in the apical four-chamber view. PISA is more accurate for central regurgitant jets. Systolic pulmonary vein flow reversal is specific for severe MR, but is not sensitive. Echocardiographic criteria for the definition of severe mitral regurgitation are shown in following Table:

ESC guidelines 2012