Assessment of pulmonary venous flow velocity by pulsed
Doppler echocardiography can also be of value in estimating the severity of
mitral regurgitation. Normal pulmonary venous flow velocity is biphasic, with a
predominant systolic forward velocity and a lesser diastolic forward velocity in
older adults. Systolic forward velocity is reduced in patients with mitral
regurgitation, and often the diastolic velocity predominates. In severe mitral
regurgitation, the systolic flow in the pulmonary vein signal may reverse.
Systolic flow reversal is highly specific for severe regurgitation but
sensitivity is low. Unfortunately, pulmonary venous flow velocity patterns vary
considerably in patients with mitral regurgitation, and the predictive value for
regurgitation severity is low. In many laboratories, all these factors are
integrated to produce a composite estimate of the severity of regurgitation,
usually on a scale of 1 to 4, with 4 being severe mitral regurgitation. Table below exhibits the criteria for grading the severity of mitral
regurgitation.
Current Diagnosis & Treatment Cardiology 3rd Edition (McGraw-Hill) 2009