Planimetry
Recording: 2D parasternal short-axis view Determine the smallest orifice by scanning from apex to base Positioning of measurement plan can be oriented by 3D echo Lowest gain setting to visualize the whole mitral orifice Measurement: Contour of the inner mitral orifice Include commissures when opened In mid-diastole (use cine-loop) Average measurements if atrial fibrillation
Mitral flow
Recording: Continuous-wave Doppler Apical windows often suitable (optimize intercept angle) Adjust gain setting to obtain well-defined flow contour Measurement: Mean gradient from the traced contour of the diastolic mitral flow Pressure half-time from the descending slope of the E-wave (mid-diastole slope if not linear) Average measurements if atrial fibrillation
Systolic pulmonary artery pressure
Recording: Continuous-wave Doppler Multiple acoustic windows to optimize intercept angle Measurement: Maximum velocity of tricuspid regurgitant flow Estimation of right atrial pressure according to inferior vena cava diameter
Valve anatomy
Parasternal short-axis view — Measurement: Valve thickness (maximum and heterogeneity) Commissural fusion Extension and location of localized bright zones (fibrous nodules or calcification) Parasternal long-axis view — Measurement: Valve thickness Extension of calcification Valve pliability Subvalvular apparatus (chordal thickening, fusion, or shortening) Subvalvular apparatus (chordal thickening, fusion, or shortening) Apical two-chamber view — Measurement: Subvalvular apparatus (chordal thickening, fusion, or shortening) Detail each component and summarize in a score