Echocardiographic Assessment of Mitral Valve Disease

Initial Imaging Approach

The European Society of Cardiology recommends beginning with 2D transthoracic echocardiography (TTE) using multiple standardized views to evaluate all components of the mitral valve apparatus, including the annulus, leaflets, chordae tendineae, papillary muscles, and left ventricular attachments 2, 3
Essential TTE views include the parasternal long-axis view, parasternal short-axis view, apical four-chamber view, and apical two-chamber view, which provide a comprehensive assessment of mitral valve morphology and function 2, 4

The American College of Cardiology recommends documenting leaflet structure, including the six individual scallops, and identifying specific pathology such as flail leaflet, ruptured papillary muscle, or large coaptation defect 2
The European Society of Cardiology recommends measuring annular dimensions using the parasternal long-axis view, with annular dilatation present when the annulus/anterior leaflet ratio is ≥1.32 2, 4
The American Heart Association recommends evaluating leaflet motion using Carpentier's classification to determine the mechanism of regurgitation 3

The European Society of Cardiology recommends using color Doppler imaging as the primary screening tool for mitral regurgitation, with semi-quantitative measures including vena contracta width, pressure half-time, and circumferential extent of paravalvular regurgitation 1
The American College of Cardiology recommends calculating quantitative parameters such as effective regurgitant orifice area (EROA), regurgitant volume, and regurgitant fraction to assess the severity of mitral regurgitation 1

The European Society of Cardiology recommends documenting left ventricular size and function to assess the impact of regurgitation and guide timing of intervention 1, 9
The American Heart Association recommends measuring left atrial size as a marker of chronicity and hemodynamic burden 1, 9

The European Society of Cardiology recommends identifying primary mitral regurgitation unfavorable features, including large central regurgitant jet, severe annular dilatation, involvement of ≥3 scallops, extensive valve calcification, and lack of valve tissue 2
The American College of Cardiology recommends identifying secondary ischemic mitral regurgitation unfavorable features, including mitral diastolic annulus diameter ≥37 mm, systolic tenting area ≥1.6 cm², and severe functional ischemic mitral regurgitation 2, 4