For the purposes of echo exams, it is important to familiarise yourself with current guidance on the assessment of valve regurgitation. We have listed a few as references to the statements below.
Carpentier classification (1) is used to classify dysfunction in leaflet mobility as follows
Type I - Normal leaflet motion
Type II - Increased leaflet mobility
Type III - Reduced leaflet mobility (IIIa in systole and diastole, IIIb in systole alone)
It is not used to grade LV dysfunction.
It has been discussed in other sections of this course, but to quickly reiterate that acute regurgitation of any sort does not cause ventricular hypertrophy or dilatation, as these processes are time-dependent and are seen in chronic ventricular overload. In chronic overload of the ventricle due to mitral or tricuspid regurgitation, the amount of blood entering the ventricle from the atrium is increased, implying an increased preload.
In the case of aortic or pulmonary regurgitation, the ventricle has to pump more blood as most of it has returned back to it from the aorta or pulmonary artery, implying an increase in afterload. Both of these cases will result in a degree of ventricular hypertrophy, and over time, dilatation.
Imaging of the left heart with transthoracic echo is best obtained in end-expiration. Valsalva should be avoided as image quality will be poor. At least 3 cardiac cycles of LV contraction should be obtained in sinus, and 5 in atrial fibrillation (2).
Just of note, the ESC recommends using contrast imaging if <80% of the endocardial border is visible clearly. (2,3)
References
1. Carpentier A, Chauvaud S, Fabiani JN, Deloche A, Relland J, Lessana A, et al. Reconstructive surgery of mitral valve incompetence: ten-year appraisal. J Thorac Cardiovasc Surg 1980;79:338-48.
2. Patrizio Lancellotti, Christophe Tribouilloy, Andreas Hagendorff, Luis Moura,Bogdan A. Popescu, Eustachio Agricola, Jean-Luc Monin, Luc A. Pierard, Luigi Badano,Jose L. Zamorano, Rosa Sicari, Alec Vahanian, and Jos R.T.C. Roelandt. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease)Eur J Echocardiogr (2010) 11(3): 223-244
3. Roxy Senior, Harald Becher, Mark Monaghan, Luciano Agati, Jose Zamorano,Jean Louis Vanoverschelde, and Petros Nihoyannopoulos. Contrast echocardiography: evidence-based recommendations by European Association of Echocardiography. Eur J Echocardiogr (2009) 10(2): 194-212
Carpentier classification (1) is used to classify dysfunction in leaflet mobility as follows
Type I - Normal leaflet motion
Type II - Increased leaflet mobility
Type III - Reduced leaflet mobility (IIIa in systole and diastole, IIIb in systole alone)
It is not used to grade LV dysfunction.
It has been discussed in other sections of this course, but to quickly reiterate that acute regurgitation of any sort does not cause ventricular hypertrophy or dilatation, as these processes are time-dependent and are seen in chronic ventricular overload. In chronic overload of the ventricle due to mitral or tricuspid regurgitation, the amount of blood entering the ventricle from the atrium is increased, implying an increased preload.
In the case of aortic or pulmonary regurgitation, the ventricle has to pump more blood as most of it has returned back to it from the aorta or pulmonary artery, implying an increase in afterload. Both of these cases will result in a degree of ventricular hypertrophy, and over time, dilatation.
Imaging of the left heart with transthoracic echo is best obtained in end-expiration. Valsalva should be avoided as image quality will be poor. At least 3 cardiac cycles of LV contraction should be obtained in sinus, and 5 in atrial fibrillation (2).
Just of note, the ESC recommends using contrast imaging if <80% of the endocardial border is visible clearly. (2,3)
References
1. Carpentier A, Chauvaud S, Fabiani JN, Deloche A, Relland J, Lessana A, et al. Reconstructive surgery of mitral valve incompetence: ten-year appraisal. J Thorac Cardiovasc Surg 1980;79:338-48.
2. Patrizio Lancellotti, Christophe Tribouilloy, Andreas Hagendorff, Luis Moura,Bogdan A. Popescu, Eustachio Agricola, Jean-Luc Monin, Luc A. Pierard, Luigi Badano,Jose L. Zamorano, Rosa Sicari, Alec Vahanian, and Jos R.T.C. Roelandt. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease)Eur J Echocardiogr (2010) 11(3): 223-244
3. Roxy Senior, Harald Becher, Mark Monaghan, Luciano Agati, Jose Zamorano,Jean Louis Vanoverschelde, and Petros Nihoyannopoulos. Contrast echocardiography: evidence-based recommendations by European Association of Echocardiography. Eur J Echocardiogr (2009) 10(2): 194-212
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