Current Cardiology Reports

, Volume 9, Issue 2, pp 105–111 | Cite as

A practical approach to the quantification of valvular regurgitation

  • Ron Jacob
  • William J. Stewart
Valvular Heart Disease


This article reviews the methods of determining the severity of mitral and aortic regurgitation, primarily the quantitation using Doppler echocardiography. The Doppler methods, including spatial mapping, proximal flow convergence, vena contracta, continuous-wave Doppler density, and upstream or downstream effects are explained. Various practical pitfalls and performance issues that impact the reliability of these techniques are discussed.


Pulmonary Vein Mitral Regurgitation Aortic Regurgitation Severe Mitral Regurgitation Valvular Regurgitation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Hunt D, Baxley WA, Kennedy JW, et al.:Quantitative evaluation of cineaortography in the assessment of aortic regurgitation.Am J Cardiol 1973,31:696–700.PubMedCrossRefGoogle Scholar
  2. 2.
    Abbasi AS, Allen MW, DeCristofaro D, Ungar I:Detection and estimation of the degree of mitral regurgitation by range-gated pulsed Doppler echocardiography.Circulation 1980,61:143–147.PubMedGoogle Scholar
  3. 3.
    Glockner JF, Johnston DL, McGee KP:Evaluation of cardiac valvular disease with MR imaging: qualitative and quantitative techniques.Radiographics 2003,23:e9.PubMedCrossRefGoogle Scholar
  4. 4.
    Of major importance Lang RM, Bierig M, Devereux RB, et al.:Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.J Am Soc Echocardiogr 2005,18:1440–1463. This recent publication sets out specific guidelines for the measurement of chamber size and great vessels.PubMedCrossRefGoogle Scholar
  5. 5.
    Feigenbaum HA:Feigenbaum’s Echocardiography, edn 6. Edited by Feigenbaum HA, William RT. Philadelphia: Lippincott Williams & Wilkins; 2005:324–325.Google Scholar
  6. 6.
    Chen CG, Thomas JD, Anconina J, et al.:Impact of impinging wall jet on color Doppler quantification of mitral regurgitation.Circulation 1991,84:712–720.PubMedGoogle Scholar
  7. 7.
    Grewal KS, Malkowski MJ, Piracha AR, et al.:Effect of general anesthesia on the severity of mitral regurgitation by transesophageal echocardiography.Am J Cardiol 2000,85:199–203.PubMedCrossRefGoogle Scholar
  8. 8.
    Zoghbi WA, Enriquez-Sarano M, Foster E, et al.:Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography.J Am Soc Echocardiogr 2003,16:777–802.PubMedCrossRefGoogle Scholar
  9. 9.
    Vandervoort PM, Rivera JM, Mele D, et al.:Application of color Doppler flow mapping to calculate effective regurgitant orifice area. An in vitro study and initial clinical observations.Circulation 1993,88:1150–1156.PubMedGoogle Scholar
  10. 10.
    Schwammenthal E, Chen C, Benning F, et al.:Dynamics of mitral regurgitant flow and orifice area. Physiologic application of the proximal flow convergence method: clinical data and experimental testing.Circulation 1994,90:307–322.PubMedGoogle Scholar
  11. 11.
    Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, et al.:Quantitative determinants of the outcome of asymptomatic mitral regurgitation.N Engl J Med 2005,352:875–883.PubMedCrossRefGoogle Scholar
  12. 12.
    Of importance Abhayaratna WP, Seward JB, Appleton CP, et al.:Left atrial size: physiologic determinants and clinical applications.J Am Coll Cardiol 2006,47:2357–2363. Review article about the clinical utility of looking at left atrial size in various forms of cardiovascular disease.PubMedCrossRefGoogle Scholar
  13. 13.
    Klein AL, Savage RM, Kahan F, et al.:Experimental and numerically modeled effects of altered loading conditions on pulmonary venous flow and left atrial pressure in patients with mitral regurgitation.J Am Soc Echocardiogr 1997,10:41–51.PubMedCrossRefGoogle Scholar
  14. 14.
    Pu M, Griffin BP, Vandervoort PM, et al.:The value of assessing pulmonary venous flow velocity for predicting severity of mitral regurgitation: a quantitative assessment integrating left ventricular function.J Am Soc Echocardiogr 1999,12:736–743.PubMedCrossRefGoogle Scholar
  15. 15.
    Kizilbash AM, Willett DL, Brickner ME, et al.:Effects of afterload reduction on vena contracta width in mitral regurgitation.J Am Coll Cardiol 1998,32:427–431.PubMedCrossRefGoogle Scholar
  16. 16.
    Stewart WJ, Jiang L, Mich R, et al.:Variable effects of changes in flow rate through the aortic, pulmonary and mitral valves on valve area and flow velocity: impact on quantitative Doppler flow calculations.J Am Coll Cardiol 1985,6:653–662.PubMedGoogle Scholar
  17. 17.
    Pu M, Vandervoort PM, Griffin BP, et al.:Quantification of mitral regurgitation by the proximal convergence method using transesophageal echocardiography. Clinical validation of a geometric correction for proximal flow constraint.Circulation 1995,92:2169–2177.PubMedGoogle Scholar
  18. 18.
    Perry GJ, Helmcke F, Nanda NC, et al.:Evaluation of aortic insufficiency by Doppler color flow mapping.J Am Coll Cardiol 1987,9:952–959.PubMedCrossRefGoogle Scholar
  19. 19.
    touche T, Prasquier R, Nitenberg A, et al.:Assessment and follow-up of patients with aortic regurgitation by an updated Doppler echocardiographic measurement of the regurgitant fraction in the aortic arch.Circulation 1985,72:819–824.PubMedGoogle Scholar
  20. 20.
    Reimold SC, Maier SE, Aggarwal K, et al.:Aortic flow velocity patterns in chronic aortic regurgitation: implications for Doppler echocardiography.J Am Soc Echocardiogr 1996,9:675–683.PubMedCrossRefGoogle Scholar
  21. 21.
    Ishii M, Jones M, Shiota T, et al.:What is the validity of continuous wave Doppler grading of aortic regurgitation severity? A chronic animal model study.J Am Soc Echocardiogr 1998,11:332–337.PubMedCrossRefGoogle Scholar
  22. 22.
    Griffin BP, Flachskampf FA, Siu S, et al.:The effects of regurgitant orifice size, chamber compliance, and systemic vascular resistance on aortic regurgitant velocity slope and pressure half-time.Am Heart J 1991,122(4 Pt 1):1049–1056.PubMedCrossRefGoogle Scholar
  23. 23.
    Tribouilloy CM, Enriquez-Sarano M, Fett SL, et al.:Application of the proximal flow convergence method to calculate the effective regurgitant orifice area in aortic regurgitation.J Am Coll Cardiol 1998,32:1032–1039.PubMedCrossRefGoogle Scholar
  24. 24.
    Tribouilloy CM, Enriquez-Sarano M, Bailey KR, et al.:Assessment of severity of aortic regurgitation using the width of the vena contracta: a clinical color Doppler imaging study.Circulation 2000,102:558–564.PubMedGoogle Scholar

Copyright information

© Current Medicine Group LLC 2007

Authors and Affiliations

  1. 1.Department of Cardiovascular MedicineThe Cleveland Clinic FoundationClevelandUSA

Personalised recommendations