Težina mitralne regurgitacije (MR) s multiplim regurgitirajućim mlazevima često se podcjeni standardnom transtorakalnom ehokardiografskom (TTE) pretragom, jer se svi mlazevi ne otkriju. Od svih Doppler metoda jedino je kvantitativno PW Doppler mjerenje primjenjivo u ovih bolesnika jer PISA nije točna, a vena kontrakta je primjenjiva samo kod jednog regurgitacijskog mlaza.
Prikazujemo 57-godišnjeg bolesnika s malim centralnim regurgitacijskim mlazom na TTE u kojeg smo učinili transezofagijskom ehokardiografijom (TEE) zbog smanjene tolerancije napora kod normalne funkcije lijeve klijetke, morfološki nepromijenjene mitralne valvule i normalnog nalaza koronarografije uz prisustvo glasnog apikalnog holostistoličkog šuma. TEE je otkrio dva dodatna ekscentrična regurgitirajuća mlaza. Kvantitativnom PW Doppler metodom izračunan je regurgitacijski volumen od 55 ml i ERO 0.35 cm2, što odgovara srednje teškoj do teškoj MR.
Želimo naglasiti da se simptomi i fizikalni nalaz ne smiju zanemariti u postupku integrativne ultrazvučne procjene težine MR.he severity of mitral regurgitation (MR) with multiple regurgitant jets is often underestimated on standard transthoracic ehocardiography (TTE) examination, since all jets are usually not appreciated. On the other hand, of all Doppler methods only quantitative PW Doppler measurement is applicable in these patients since PISA is not as accurate and vena contracta works well only for single jets.
We present a 57-year-old patient with small and narrow central jet on TTE in whom transesophageal echocardiography (TEE) was performed because of loud apical holosystolic murmur and low effort tolerance in the presence of normal left ventricular function, normal mitral valve and coronary artery anatomy. TEE disclosed two additional significant eccentric jets. Regurgitant volume of 55 ml/beat and ERO 0,35 cm2 was calculated with quantitative PW Doppler method which corresponded to moderate to severe MR.
We stress again the importance of integrative approach in the assessment of MR severity, in which symptoms, physical examination and hemodynamic consequences of MR should not be neglected
