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Quantification of primary mitral regurgitation by echocardiography: A practical appraisal

The accurate quantification of primary mitral regurgitation (MR) and its consequences on cardiac remodeling is of paramount importance to determine the best timing for surgery in these patients. The recommended echocardiographic grading of primary MR severity relies on an integrated multiparametric...

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Autores principales: Altes, Alexandre, Vermes, Emmanuelle, Levy, Franck, Vancraeynest, David, Pasquet, Agnès, Vincentelli, André, Gerber, Bernhard L., Tribouilloy, Christophe, Maréchaux, Sylvestre
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10036770/
https://www.ncbi.nlm.nih.gov/pubmed/36970355
http://dx.doi.org/10.3389/fcvm.2023.1107724
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author Altes, Alexandre
Vermes, Emmanuelle
Levy, Franck
Vancraeynest, David
Pasquet, Agnès
Vincentelli, André
Gerber, Bernhard L.
Tribouilloy, Christophe
Maréchaux, Sylvestre
author_facet Altes, Alexandre
Vermes, Emmanuelle
Levy, Franck
Vancraeynest, David
Pasquet, Agnès
Vincentelli, André
Gerber, Bernhard L.
Tribouilloy, Christophe
Maréchaux, Sylvestre
author_sort Altes, Alexandre
collection PubMed
description The accurate quantification of primary mitral regurgitation (MR) and its consequences on cardiac remodeling is of paramount importance to determine the best timing for surgery in these patients. The recommended echocardiographic grading of primary MR severity relies on an integrated multiparametric approach. It is expected that the large number of echocardiographic parameters collected would offer the possibility to check the measured values regarding their congruence in order to conclude reliably on MR severity. However, the use of multiple parameters to grade MR can result in potential discrepancies between one or more of them. Importantly, many factors beyond MR severity impact the values obtained for these parameters including technical settings, anatomic and hemodynamic considerations, patient's characteristics and echocardiographer' skills. Hence, clinicians involved in valvular diseases should be well aware of the respective strengths and pitfalls of each of MR grading methods by echocardiography. Recent literature highlighted the need for a reappraisal of the severity of primary MR from a hemodynamic perspective. The estimation of MR regurgitation fraction by indirect quantitative methods, whenever possible, should be central when grading the severity of these patients. The assessment of the MR effective regurgitant orifice area by the proximal flow convergence method should be used in a semi-quantitative manner. Furthermore, it is crucial to acknowledge specific clinical situations in MR at risk of misevaluation when grading severity such as late-systolic MR, bi-leaflet prolapse with multiple jets or extensive leak, wall-constrained eccentric jet or in older patients with complex MR mechanism. Finally, it is debatable whether the 4-grades classification of MR severity would be still relevant nowadays, since the indication for mitral valve (MV) surgery is discussed in clinical practice for patients with 3+ and 4+ primary MR based on symptoms, specific markers of adverse outcome and MV repair probability. Primary MR grading should be seen as a continuum integrating both quantification of MR and its consequences, even for patients with presumed “moderate” MR.
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spelling pubmed-100367702023-03-25 Quantification of primary mitral regurgitation by echocardiography: A practical appraisal Altes, Alexandre Vermes, Emmanuelle Levy, Franck Vancraeynest, David Pasquet, Agnès Vincentelli, André Gerber, Bernhard L. Tribouilloy, Christophe Maréchaux, Sylvestre Front Cardiovasc Med Cardiovascular Medicine The accurate quantification of primary mitral regurgitation (MR) and its consequences on cardiac remodeling is of paramount importance to determine the best timing for surgery in these patients. The recommended echocardiographic grading of primary MR severity relies on an integrated multiparametric approach. It is expected that the large number of echocardiographic parameters collected would offer the possibility to check the measured values regarding their congruence in order to conclude reliably on MR severity. However, the use of multiple parameters to grade MR can result in potential discrepancies between one or more of them. Importantly, many factors beyond MR severity impact the values obtained for these parameters including technical settings, anatomic and hemodynamic considerations, patient's characteristics and echocardiographer' skills. Hence, clinicians involved in valvular diseases should be well aware of the respective strengths and pitfalls of each of MR grading methods by echocardiography. Recent literature highlighted the need for a reappraisal of the severity of primary MR from a hemodynamic perspective. The estimation of MR regurgitation fraction by indirect quantitative methods, whenever possible, should be central when grading the severity of these patients. The assessment of the MR effective regurgitant orifice area by the proximal flow convergence method should be used in a semi-quantitative manner. Furthermore, it is crucial to acknowledge specific clinical situations in MR at risk of misevaluation when grading severity such as late-systolic MR, bi-leaflet prolapse with multiple jets or extensive leak, wall-constrained eccentric jet or in older patients with complex MR mechanism. Finally, it is debatable whether the 4-grades classification of MR severity would be still relevant nowadays, since the indication for mitral valve (MV) surgery is discussed in clinical practice for patients with 3+ and 4+ primary MR based on symptoms, specific markers of adverse outcome and MV repair probability. Primary MR grading should be seen as a continuum integrating both quantification of MR and its consequences, even for patients with presumed “moderate” MR. Frontiers Media S.A. 2023-03-10 /pmc/articles/PMC10036770/ /pubmed/36970355 http://dx.doi.org/10.3389/fcvm.2023.1107724 Text en © 2023 Altes, Vermes, Levy, Vancraeynest, Pasquet, Vincentelli, Gerber, Tribouilloy and Marechaux. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Altes, Alexandre
Vermes, Emmanuelle
Levy, Franck
Vancraeynest, David
Pasquet, Agnès
Vincentelli, André
Gerber, Bernhard L.
Tribouilloy, Christophe
Maréchaux, Sylvestre
Quantification of primary mitral regurgitation by echocardiography: A practical appraisal
title Quantification of primary mitral regurgitation by echocardiography: A practical appraisal
title_full Quantification of primary mitral regurgitation by echocardiography: A practical appraisal
title_fullStr Quantification of primary mitral regurgitation by echocardiography: A practical appraisal
title_full_unstemmed Quantification of primary mitral regurgitation by echocardiography: A practical appraisal
title_short Quantification of primary mitral regurgitation by echocardiography: A practical appraisal
title_sort quantification of primary mitral regurgitation by echocardiography: a practical appraisal
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10036770/
https://www.ncbi.nlm.nih.gov/pubmed/36970355
http://dx.doi.org/10.3389/fcvm.2023.1107724
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