Thread by @JACCJournals

What are your pearls for assessing the mechanism & severity of #mitralregurgitation by #EchoFirst?

#JACCIMG presents an imaging-based curriculum to review functional #mitralvalve regurgitation for #CardioTwitter.

Follow/share this #Tweetorial! (1/15) bit.ly/3gw5MZ2

#JACCIMG Tweetorial Mitral regurgitation (2/15)

Case 1: What is the pathology shown?

JACCIMG #Tweetorial (3/15)

Shown is an example of flail leaflet of the #mitralvalve at the P2 segment.

Surgical #mitralvalve repair is the gold standard; due to prohibitive risk, the patient underwent successful percutaneous repair #TMVR, guided by 3D #EchoFirst.

#JACCIMG Tweetorial Mitral regurgitation (4/15)

Case 2: What is the pathology shown?

#JACCIMG Tweetorial Mitral Regurgitation (5/15)

Shown is mitral annular disjunction (MAD). What findings are associated with MAD? bit.ly/3aAshZ8 #vhdMR

#JACCIMG Tweetorial (6/15)

All of the listed findings (E) are associated with MAD.

Look out for Pickelhaube sign (eg, like a “spike” on a German helmet) – a spike in systolic phase on tissue doppler imaging associated with MAD and leaflet tension. bit.ly/32eU90k

#JACCIMG #Tweetorial Mitral regurgitation (7/15)

Case 3: Does this asymptomatic man with a late systolic click and bileaflet prolapse have severe #mitralregurgitation and require #mitralvalve surgery?

#JACCIMG Tweetorial Mitral regurgitation (8/15)

This patient has late systolic #mitralregurgitation; this typically does not need surgery! Avoid using PISA EROA when #vhdMR is not holosystolic & use regurgitant volume instead. bit.ly/32eU90k

#JACCIMG Tweetorial Mitral regurgitation (9/15)

Biphasic #MR is another pitfall in #vhdMR evaluation & is rarely severe.

Avoid overtracing the jet or turning up doppler gains to make the signal look holosystolic – this may overestimate the PISA bit.ly/2RU0GeR

#JACCIMG Tweetorial Mitral regurgitation (10/15)

Case 4: What is the pathology and what is the optimal therapy: surgical valve replacement, surgical valve repair, transcatheter edge to edge repair (#MitraClip), or medical therapy?

#JACCIMG Tweetorial Mitral regurgitation (11/15)

Shown is a case of Carpentier Type IIIa #mitralregurgitation w/ restricted leaflet motion. Surgical replacement is recommended from high risk of post #MitraClip mitral stenosis due to response to underlying inflammatory disease.

#JACCIMG Tweetorial Mitral regurgitation (12/15)

Case 5: What is the mechanism of #mitralregurgitation in this case?

#JACCIMG Tweetorial Mitral regurgitation (13/15)

Case 5: Functional (secondary) #mitralregurgitation with LV dysfunction is shown. Here are key #EchoFirst clips. What treatment is recommended?

#JACCIMG Tweetorial (14/15)

Case 5: In functional (secondary) MR + LV dysfunction, optimal treatment starts w/ maximal medical therapy, rarely achieved in practice

From #COAPT, #TMVR improved outcomes for secondary MR in LVEF 20-50%, ideally w/ LV end systolic diameter <7cm

#JACCIMG Tweetorial Mitral regurgitation (15/15)

Thank you for following & sharing this #JACCIMG Tweetorial on #vhdMR!

Follow #JACCIMG @JACCJournals and check out the full March 2021 special issue on secondary mitral regurgitation by going here: bit.ly/3tLzcGB