Topic Overview

A crucial step in the diagnostic process is determining how serious your case of mitral valve regurgitation (MR) is, because treatment depends largely on severity. At a minimum, your doctor will use an echocardiogram to gauge the condition of your mitral valve. And depending on your situation, your doctor may need more information and extra diagnostic tests.

To find out the severity of your MR, your doctor will look for:

• The size of the left ventricle at the end of the contraction (end systolic dimension, or ESD). In chronic MR, the left ventricle expands in size as it tries to accommodate the larger volumes of blood flowing into the chamber. The larger the left ventricle, the more advanced the MR. This applies only to the chronic form of the disease, since the left ventricle does not expand in acute MR.
• The ejection fraction. This number shows the efficiency of your heart. The ejection fraction is the amount of blood pumped out of the ventricle (stroke volume) divided by the total amount of blood in the left ventricle at rest. The smaller the ejection fraction, the harder your heart must work to pump sufficient volumes of blood outward.

Also important is:

• The size of the left atrium.
• An estimate of the pressure in the artery that takes blood to your lungs when the heart contracts (pulmonary systolic pressure).
• Examination of the size of the leak, using a form of ultrasound called Doppler echocardiography (Doppler ultrasound).
• Whether there is evidence of reversal in the blood flow from the lungs into the left atrium.

It is important to remember that the ejection fraction (EF) and end systolic dimension (ESD) are not the final judges in determining the severity of your condition. Your doctor will use these measurements, as well as the others noted above and your symptoms, to determine the severity of your MR.