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Carpentier classification of mitral regurgitation on echo
Carpentier’s classification groups mitral regurgitation by how the leaflets move: it points to the mechanism, the direction of the jet and the repair.
Type I: normal motion
A dilated annulus, a hole or a cleft. Jet: Central, or through the leaflet.
Atrial functional MR · Mitral annular calcification · Leaflet perforation · Cleft of the anterior leaflet · Endocarditis
Type II: excessive motion
Prolapse (≥2 mm into the LA) or a flail edge. Jet: Away from the abnormal leaflet.
Single-scallop prolapse · Flail leaflet (ruptured chord) · Barlow disease (bileaflet prolapse) · Endocarditis
Type IIIa: restricted in systole and diastole
Thick, stiff leaflets: rheumatic, with fused commissures, or calcific. Jet: Often posterior.
Type IIIb: restricted in systole
Tethering by a remodelled LV (secondary MR). Jet: Toward the restricted leaflet, or central.
Ischaemic MR (posterior tethering) · Functional MR in a dilated LV (symmetric tethering)
SAM: outside the classification
The anterior leaflet is pulled into the outflow tract. Jet: Posterior, mid-to-late systolic.