Mitral valve training › Guides › Endocarditis
Mitral valve endocarditis on echo: vegetations and leaflet damage
What to look for: A mobile mass on a leaflet; a hole or a flail segment.
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.
Carpentier Type II: excessive motion. Prolapse (≥2 mm into the LA) or a flail edge. Jet: away from the abnormal leaflet. The classification
Carpentier Type II: excessive motion. Prolapse (≥2 mm into the LA) or a flail edge. Jet: away from the abnormal leaflet. The classification
Key findings
- A vegetation is an oscillating mass attached to a valve, usually on its upstream (atrial) side, moving independently of the leaflet.
- Look for the damage it does: perforation (type I), a flail segment or ruptured chord (type II), abscess and fistula.
- TOE is recommended when TTE is negative or non-diagnostic and endocarditis is still suspected, with prosthetic valves or devices, and to look for complications.
- Surgery is considered urgently for heart failure from severe regurgitation, uncontrolled infection (abscess, persisting bacteraemia), or a vegetation ≥10 mm with an embolic event.
Grading the regurgitation (primary MR)
- Severe: vena contracta ≥7 mm, EROA ≥0.40 cm², regurgitant volume ≥60 ml, regurgitant fraction ≥50%. Mild: vena contracta <3 mm, EROA <0.20 cm², regurgitant volume <30 ml.
- Specific signs of severe MR: a flail leaflet or ruptured papillary muscle, a large flow convergence, and systolic flow reversal in the pulmonary veins; a dense, triangular CW signal and an E-wave-dominant inflow support it.
- Integrate several signs: no single measurement grades MR on its own.
Pitfalls
- Degenerative thickening, calcium, ruptured chords and small mobile strands can look like vegetations: the clinical picture and TOE decide.
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
Leaflet perforation · Flail leaflet (ruptured chord)
Educational simulation to use under the supervision of a clinical tutor — not for clinical use.