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The Evaluation of Mitral Regurgitation:

A Balanced Approach for the Cardiac Sonographer

Mary Grace Warner, MD

Christopher Appleton, MD

School of Cardiac Ultrasound and the Cardiovascular Laboratory, Arizona Heart Institute Foundation, Phoenix, Arizona; Echocardiography Laboratory, VA Medical Center, Tucson, Arizona.

In the late 1970s, conventional Doppler techniques, specifically pulsed-wave (PW) Doppler and continuouswave (CW) Doppler, enabled the cardiac sonographer to detect the presence and determine the severity of mitral regurgitation. In the mid 1980s, with the introduction of color flow Doppler, the regurgitant jet area (RJA)/left atrial area (LAA) ratio quickly became the yardstick by which the severity of mitral regurgitation was judged. This simple ratio came to overshadow or even replace the conventional Doppler techniques that had preceded the ratio method. It is our contention that there is currently an overemphasis on the RJA/LAA ratio and we believe that a more balanced approach should be adopted in order to determine the severity of mitral regurgitation.

Key Words: mitral regurgitation • RJA/LAA ratio • volume overload • proximal acceleration

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