Lvef

Frequency of follow-up

Mild MR

ESD normal

Normal EF

5 yr

Moderate MR

ESD normal

Normal EF

1-2 yr

Moderate MR

ESD > 40 mm

<65%

1 yr

Severe MR

ESD normal

Normal EF

1 yr

Severe MR

ESD > 40 mm

<65%

6 mo

Adapted from: Otto CM. Evaluation and management of chronic asymptomatic mitral regurgitation. N Engl. J Med 2001;345:740-746.

Adapted from: Otto CM. Evaluation and management of chronic asymptomatic mitral regurgitation. N Engl. J Med 2001;345:740-746.

and small errors in measurement easily lead to large errors in calculation. Therefore, they should be applied in the context of the patient, without reliance on a single measure.

two-dimensional echocardiographic parameters for grading mr severity

LV Performance

Indices of LV systolic function—left ventricular end-systolic and end-diastolic dimensions, ejection fraction, wall thickness, and fractional shortening—are the most important echocardiographic barometers of the hemodynamic effects of MR on global cardiac function (see Chapter 5 for LV quantification).

Three major phases of MR on and their impact on LV performance are summarized in Fig. 13.

1. Acute MR phase.

2. Chronic compensated MR.

3. Chronic decompensated MR.

LV end-systolic dimensions (Fig. 14) and LV ejection fraction (LVEF) reflect the heart's ability to adapt, and therefore influences the frequency of clinical follow-up, timing of surgical intervention, and outcomes following

Table 7

Echocardiographic Signs and Surgical Considerations in MR

Variables

Measures

Comment

Clinical symptoms LVEF

ESD (LVIDs) EDD (LVIDd) Surgical considerations

Symptomatic vs Asymptomatic <50 mm <50-55 mm >70 mm

Repair vs Replacement

Presence of symptoms favors earlier intervention Sign of decompensation Sign of decompensation Sign of decompensation

Earlier interventions with valve-sparing surgery favored

Left Ventricle Lvef
End-systole End-diastole

Left ventricular dimensions*

LV Intern»] Diameters (PLAX)

Norm!«) Kungr (em) (mean is Ö)

Index adjusted for hod y surface area (cm/m2)

End-diastole: EDD or LVIDd

3,5-6.0

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