Complicated Double-Orifice Mitral Regurgitation: Combined Hemodynamic Assessment Using Echocardiography and Four-Dimensional Flow Magnetic Resonance Imaging

Figures

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  Figure 1. Electrocardiogram demonstrating prolonged QT interval of 452 msec (corrected QT interval 497 msec).

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  Figure 2. Mitral valve prolapse–related factors detected by echocardiography and magnetic resonance imaging. (A) Three-chamber transthoracic echocardiogram with mild mitral annular disjunction. (B) Tissue Doppler of the lateral annulus illustrating the Pickelhaube sign (sudden apical myocardial movement in late systole). (C) Three-chamber cine MRI also demonstrating the disjunction. All these factors have been associated with arrhythmias in mitral valve prolapse.

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  Figure 3. Double-orifice MR captured by color Doppler echocardiography and 4D flow MRI. Velocity magnitude on cross-sectional 4D flow MRI data are shown, where corresponding two-dimensional cine MRI data are shown on the background. (A, C) Two centrally directed regurgitant jets (anterior jet, white arrow; posterior jet, orange arrow) captured in two-chamber view. (B, D) Anatomic locations of regurgitation visualized in short-axis view. AO, Aorta; LA, left atrium; LV, left ventricle; PA, pulmonary artery; RA, right atrium; SVC, superior vena cava.

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  Figure 4. Wall-constrained posterior regurgitation flow convergence zone on color Doppler echocardiography. White lines indicate that the observed angle of convergence zone was reduced to 120° from its expected full hemispheric angle of 180°. Thus, the calculated EROA was reduced by one third.

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  Figure 5. Electrocardiogram during recovery after stress echocardiography demonstrating a five-beat run of rapid PMVT.

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  Figure 6. Volumetric visualization of regurgitant jets and flow quantification by 4D flow MRI. (A) Three-dimensional streamlines at late systole illustrating two distinct regurgitant jets. (B) Transvalvular flow rate profiles for aortic and mitral flow. The profiles were acquired by repositioning measurement planes to the location of valves at each cardiac phase. Ao, Aorta; DAo, descending aorta; LA, left atrium; LV, left ventricle; PA, pulmonary artery.