What is the assessment of the mitral valve with a peak velocity of 1.2 meters per second (m/s), no stenosis, a peak gradient of 6 millimeters of mercury (mmHg), a mean gradient of 2 mmHg, trivial regurgitation, and a mitral valve area (MVA) of 3.6 square centimeters (cm²) using the pressure half-time method?

From the Guidelines

The mitral valve appears normal based on the provided echocardiographic parameters, and no intervention is required. The peak velocity is 1.2 m/s, which falls within normal limits (typically <1.3 m/s) 1. There is no evidence of mitral stenosis, with a low peak gradient of 6 mmHg and mean gradient of 2 mmHg (normal mean gradient is typically <5 mmHg) 1.

Key Findings

• The mitral valve area is 3.6 cm², measured by pressure half-time method, which is well within normal range (normal MVA is 4-6 cm²) 1.
• Only trivial regurgitation is noted, which is a common finding even in normal hearts and is not clinically significant.
• The absence of elevated gradients across the valve and the normal valve area confirm good leaflet mobility and appropriate valve function during the cardiac cycle.

Clinical Implications

• Echocardiography is the preferred method for diagnosing mitral stenosis and for assessing its severity and haemodynamic consequences 1.
• Valve area using planimetry is the reference measurement of mitral stenosis severity, whereas mean transvalvular gradient and pulmonary artery pressures are also important parameters to assess 1.
• A comprehensive assessment of valve morphology is important for the treatment strategy, and scoring systems have been developed to help assess suitability for intervention 1.
• In this case, all parameters indicate normal function with only physiologic trivial regurgitation, and therefore, no intervention is required for this mitral valve.

From the Research

Mitral Valve Structure and Function

• The mitral valve is a complex, dynamic, and functional apparatus that can be altered by a wide range of disorders leading to stenosis or regurgitation 2.
• The valve anatomy includes the annulus, leaflets, subvalvular apparatus, left ventricle, and left atrium, and any abnormality in these components may lead to mitral valve dysfunction 3.
• Normal mitral valve anatomy and function can be accurately characterized using noninvasive cardiac imaging techniques such as echocardiography, three-dimensional echocardiography, computed tomography, and cardiac magnetic resonance 3.

Mitral Regurgitation

• Mitral regurgitation (MR) is increasingly prevalent and poses an important public health problem 4.
• MR can be classified as primary (i.e., lesion in the mitral apparatus) or secondary (caused by left ventricular geometrical alterations) 5.
• The physiologic consequences of mitral regurgitation include reduced forward stroke volume, increased left atrial volume and pressure, and reduced resistance to left ventricular ejection 6.
• Symptoms of chronic mitral regurgitation include dyspnea and fatigue, resulting from pulmonary venous hypertension and low cardiac output 6.

Diagnosis and Treatment

• Echocardiography is the most useful noninvasive technique for evaluating patients with mitral regurgitation, and can establish the diagnosis and estimate the severity of the regurgitation 6.
• Cardiac catheterization and angiography are usually reserved for patients being considered for valvular surgery 6.
• Medical therapy for symptomatic patients includes digitalis, diuretics, and vasodilators, and valvular surgery should be considered when symptoms occur despite this therapy 6.
• Mitral valve repair is preferable to valve replacement, and percutaneous approaches to repair and/or replace the mitral valve are being extensively investigated 4, 5.