Q. How to investigate mitral regurgitation by Echo?

2 D echocardiography will help determine the morphology and etiology of mitral regurgitation. Rheumatic mitral regurgitation is characterized by thickened leaflets and chordae, commissural fusion and limited mobility of posterior mitral leaflet. Leaflets may contract and may not coapt with each other. In patients with SLE small vegetation may be found. In mitral valve prolapse either of the leaflets crosses the plane of mitral annulus in to left atrium during systole. Since the mitral annulus is of saddle shape an assessment should be made in para sternal long axis view than from an apical view. With myxomatous degeneration, mitral leaflets are thickened. Mitral valve prolapse may be present with no or any degree of regurgitation. A flail leaflet is diagnosed when there is complete loss of cooptation and tip of one of the leaflet prolapses in to leaflet atrium during systole. Ruptured chordae are better observed on trans esophageal echo. Mitral annular calcification with varying degrees of involvement of posterior leaflet, vegetations, perforations and cleft leaflets are obvious on 2 D echocardiographic imaging.