Skip to main content
SpringerLink
Log in

Valvular Regurgitation

  • Chapter
The ESC Textbook of Cardiovascular Imaging

Abstract

Valvular regurgitation has long been recognized as an important cause of morbidity and mortality. Non-invasive cardiac imaging, mainly including echocardiographic examination, is the method of choice to detect and quantitate the severity of the regurgitation and allows accurate estimation of the underlying mechanisms. The extent of the lesion process and the severity of valvular regurgitation may identify patients in whom valve repair is highly likely. The quantified degree of the valvular regurgitation as well as its consequences on left ventricular (LV) function is of prognostic importance. The anatomic structure of the heart in relation with the valves can be perfectly examined by echocardiography and cardiac magnetic resonance imaging (MRI). Both techniques have significantly changed the management of patients with valvular regurgitation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Duran CM. Present status of reconstructive surgery for aortic valve disease. J Card Surg. 1993;8:443–452

    Article  CAS  PubMed  Google Scholar 

  2. Lung B, Baron G, Butchart EG, et al A prospective survey of patients with valvular heart disease in Europe: the euro heart survey on valvular heart disease. Eur Heart J. 2003;24:1231–1243

    Article  Google Scholar 

  3. Zanettini R, Antonini A, Gatto G, et al Valvular heart disease and the use of dopamine agonists for Parkinson’s disease. N Engl J Med. 2007;356:39–46

    Article  CAS  PubMed  Google Scholar 

  4. Ekery DL, Davidoff R. AR: quantitative methods by echocardiography. Echocardiography. 2000;17:293–302

    Article  CAS  PubMed  Google Scholar 

  5. 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

    Article  CAS  PubMed  Google Scholar 

  6. Tribouilloy CM, Enriquez-Sarano M, Bailey KR, et al Assessment of severity of AR using the width of the vena contracta: a clinical color Doppler imaging study. Circulation. 2000;102:558–564

    CAS  PubMed  Google Scholar 

  7. Tribouilloy CM, Enriquez-Sarano M, Fett SL, et al Application of the proximal flow convergence method to calculate the effective regurgitant orifice area in AR. J Am Coll Cardiol. 1998;32: 1032–1039

    Article  Google Scholar 

  8. Vinereanu D, Ionescu AA, Fraser AG. Assessment of LV long-axis contraction can detect early myocardial dysfunction in asymptomatic patients with severe AR. Heart. 2001;85:30–36

    Article  CAS  PubMed  Google Scholar 

  9. Dulce MC, Mostbeck GH, O’Sullivan M, et al Severity of AR: interstudy reproducibility of measurements with velocity-encoded cine MR imaging. Radiology. 1992;185:235–240

    CAS  PubMed  Google Scholar 

  10. Samstad SO, Hegrenaes L, Skjaerpe T, et al Half time of the diastolic aortoventricular pressure difference by continuous wave Doppler ultrasound: a measure of the severity of AR? Br Heart J. 1989;61:336–343

    Article  CAS  PubMed  Google Scholar 

  11. Willett DL, Hall SA, Jessen ME, et al Assessment of AR by transesophageal color Doppler imaging of the vena contracta: validation against an intraoperative aortic flow probe. J Am Coll Cardiol. 2001;37:1450–1455

    Article  CAS  PubMed  Google Scholar 

  12. Shiota T, Jones M, Tsujino H, et al Quantitative analysis of AR: real-time 3-dimensional and 2-dimensional color Doppler echocardiographic method - a clinical and a chronic animal study. J Am Soc Echocardiogr. 2002;15:966–971

    Article  PubMed  Google Scholar 

  13. Fang L, Hsiung MC, Miller AP, et al Assessment of AR by live three-dimensional transthoracic echocardiographic measurements of vena contracta area: usefulness and validation. Echocardiography. 2005;22:775–781

    Article  PubMed  Google Scholar 

  14. Vahanian A, Baumgartner H, Bax J, et al Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J. 2007;28:230–268

    PubMed  Google Scholar 

  15. Piérard LA, Lancellotti P. Stress testing in valve disease. Heart. 2007;93:766–772

    Article  PubMed  Google Scholar 

  16. Wahi S, Haluska B, Pasquet A, et al Exercise echocardiography predicts development of LV dysfunction in medically and surgically treated patients with asymptomatic severe AR. Heart. 2000;84:606–614

    Article  CAS  PubMed  Google Scholar 

  17. Chatzimavroudis GP, Walker PG, Oshinski JN, et al Slice location dependence of AR measurements with MR phase velocity mapping. Magn Reson Med. 1997;37:545–551

    Article  CAS  PubMed  Google Scholar 

  18. Søndergaard L, Lindvig K, Hildebrandt P, et al Quantification of AR by magnetic resonance velocity mapping. Am Heart J. 1993;125:1081–1890

    Article  PubMed  Google Scholar 

  19. Gillam LD. Is it time to update the definition of functional mitral regurgitation? Structural changes in the mitral leaflets with left ventricular dysfunction. Circulation. 2008;118:797–799

    Article  PubMed  Google Scholar 

  20. Carpentier A, Chauvaud S, Fabiani JN, et al Reconstructive surgery of mitral valve incompetence: ten-year appraisal. J Thorac Cardiovasc Surg. 1980;79:338–348

    CAS  PubMed  Google Scholar 

  21. Waller B, Morrow A, Maron B, et al Etiology of clinically isolated, severe, chronic, pure mitral regurgitation: analysis of 97 patients over 30 years of age having mitral valve replacement. Am Heart J. 1982;104:276–288

    Article  CAS  PubMed  Google Scholar 

  22. He S, Fontaine AA, Schwammenthal E, et al An integrated mechanism for functional mitral regurgitation: leaflet restriction vs, coapting force - in vivo studies. Circulation. 1997;96:1826–1834

    CAS  PubMed  Google Scholar 

  23. 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 Echo. 2003;16:777–802

    Article  Google Scholar 

  24. 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

    CAS  PubMed  Google Scholar 

  25. Grayburn P, Fehske W, Omran H, et al Multiplane transesophageal echocardiographic assessment of mitral regurgitation by Doppler color flow mapping of the vena contracta. Am J Cardiol. 1994;74: 912–917

    Article  CAS  PubMed  Google Scholar 

  26. Enriquez-Sarano M, Bailey KR, Seward JB, et al Quantitative Doppler assessment of valvular regurgitation. Circulation. 1993;87: 841–848

    CAS  PubMed  Google Scholar 

  27. Recusani F, Bargiggia GS, Yoganathan AP, et al A new method for quantification of regurgitant flow rate using color Doppler flow imaging of the flow convergence region proximal to a discrete orifice: an in vitro study. Circulation. 1991;83:594–604

    CAS  PubMed  Google Scholar 

  28. Bonow RO, Carabello BA, Chatterjee K, et al 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008;118:e523–661

    Article  PubMed  Google Scholar 

  29. Lancellotti P, Cosyns B, Zacharakis D, et al Importance of left ventricular longitudinal function and functional reserve in patients with degenerative mitral regurgitation: assessment by 2-D speckle tracking. J Am Soc Echocardiogr. 2008;21:1331–1336

    Article  PubMed  Google Scholar 

  30. Piérard LA, Lancellotti P. The role of ischemic mitral regurgitation in the pathogenesis of acute pulmonary edema. N Engl J Med. 2004;35:1627–1634

    Article  Google Scholar 

  31. Lancellotti P, Troisfontaines P, Toussaint AC, et al Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction. Circulation. 2003;108:1713–1717

    Article  PubMed  Google Scholar 

  32. Lancellotti P, Gérard P, Piérard LA. Long-term outcome of patients with heart failure and dynamic functional mitral regurgitation. Eur Heart J. 2005;26:1528–1532

    Article  PubMed  Google Scholar 

  33. Hundley WG, Li HF, Willard JE. Magnetic resonance imaging assessment of the severity of mitral regurgitation. Comparison with invasive techniques. Circulation. 1995;92:1151–1158

    CAS  PubMed  Google Scholar 

  34. Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol. 2004;43:405–409

    Article  PubMed  Google Scholar 

  35. Schnabel R, Khaw AV, von Bardeleben RS, et al Assessment of the tricuspid valve morphology by transthoracic real-time-3D-echocardiography. Echocardiography. 2005;22:15–23

    Article  PubMed  Google Scholar 

  36. Chopra HK, Nanda NC, Fan P, et al Can two-dimensional echocardiography and Doppler color flow mapping identify the need for tricuspid valve repair? J Am Coll Cardiol. 1989;14:1266–1274

    Article  CAS  PubMed  Google Scholar 

  37. Tribouilloy CM, Enriquez-Sarano M, Bailey KR, et al Quantification of tricuspid regurgitation by measuring the width of the vena contracta with Doppler color flow imaging: a clinical study. J Am Coll Cardiol. 2000;36:472–478

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, University of Liege, Sart Tilman, Liege, b-4000, Belgium

    Luc A. Pierard & Patrizio Lancellotti

Authors
  1. Luc A. Pierard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marie Moonen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patrizio Lancellotti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luc A. Pierard .

Editor information

Editors and Affiliations

  1. Hospital Clinico San Carlos, Instituto Cardiovascular, C/Professor Martin Lagos, s/n, 28040, Madrid, Spain

    José Luis Zamorano

  2. Medical Center Dept. Cardiology, Leiden University, Albinusdreef 2, 2333, Leiden, ZA, Netherlands

    Jeroen J. Bax

  3. Dept. Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Frank E. Rademakers

  4. Turku PET Centre, Turku University Hospital, FI-20521, Turku, Finland

    Juhani Knuuti

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag London Limited Limited

About this chapter

Cite this chapter

Pierard, L.A., Moonen, M., Lancellotti, P. (2010). Valvular Regurgitation. In: Zamorano, J.L., Bax, J.J., Rademakers, F.E., Knuuti, J. (eds) The ESC Textbook of Cardiovascular Imaging. Springer, London. https://doi.org/10.1007/978-1-84882-421-8_8

Download citation

  • DOI: https://doi.org/10.1007/978-1-84882-421-8_8

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-420-1

  • Online ISBN: 978-1-84882-421-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation