Perpendicular mitral regurgitation

Mitral regurgitation jets can take many shapes

• Symmetrical
• Central
• Eccentric

The direction of the jet depends upon

• The angle of co-optation
• The  plane of  orientation of regurgitant  orifice . It  can be entirely off track with  physiological  mitral orifice .
• Degree of prolapse or shortening /subvalvular  fusion.
• Flail valve tips can guide the jet selectively into anterior/superior  or posterior aspect of LV

Rheumatic mitral valve showing poor leaflet co-optation.Patient is having significant tachycardia

 

Perpendicular 90 degree MR jets

In rheumatic heart disease  eccentric jets are more common. In dilated cardiomyopathy MR jets are often symmetrical and central as the pathology is annular dilatation.

What are  the significance of eccentric MR jets ?

• Anterior jets clinically mimic aortic stenosis as the murmur is  often well conducted to neck
• Murmurs of  posterior jets well conduct to axilla .
• Eccentric jets are often acute and compromise hemodynamics
• Suspect early infective endocarditis.Carefully look for vegetation.
• Eccentric jets make it difficult /risky  for PTMC (Note : In Mitral stenosis  +  grade 1  MR   with central jets  one can safely do PTMC)
• Severe eccentric jets can flood one of the pulmonary veins and result in unilateral or regional pulmonary hypertension or even lobar /segmental pulmonary edema