Mitral valve training › Guides › Atrial functional MR
Atrial functional mitral regurgitation on echo
What to look for: AF, a huge LA and annulus, a normal LV; a central jet.
Watch it in the simulator →Practise random casesCarpentier Type I: normal motion. A dilated annulus, a hole or a cleft. Jet: central, or through the leaflet. The classification
Key findings
- Atrial functional MR: a large LA and annulus, usually with atrial fibrillation or heart failure with preserved EF; the LV is normal in size and function and the leaflets are normal (type I), with a central jet.
- Unlike secondary MR from a dilated LV, the leaflets are not tented: the coaptation point stays near the annular plane.
- Restoring sinus rhythm can reduce it.
Grading the regurgitation (secondary MR)
- Severe: EROA ≥0.40 cm² or regurgitant volume ≥60 ml; with low flow, EROA ≥0.30 cm² or regurgitant volume ≥45 ml may already be severe.
- The orifice is often crescent-shaped along the coaptation line, so a single PISA can underestimate it.
- Severity changes with loading, rhythm and treatment: grade it on optimal heart failure treatment and note the conditions.
Pitfalls
- In atrial fibrillation, average several beats for every measurement.
In the simulator every case varies the anatomy, the jets and the measurements: watch the lesion in Learn, then grade new cases in Practice and compare your answer with the exact one.
Related
Functional MR in a dilated LV (symmetric tethering) · Ischaemic MR (posterior tethering)
Educational simulation to use under the supervision of a clinical tutor — not for clinical use.