| Grade | Description |
|---|---|
| Leaflet Mobility | |
| 1 | Highly mobile valve with only leaflet tips restricted |
| 2 | Leaflet mid and base portions have normal mobility |
| 3 | Valve continues to move forward in diastole, mainly from the base |
| 4 | No or minimal forward movement of the leaflets in diastole |
| Valve thickening | |
| 1 | Leaflets near normal in thickness (4-5 mm) |
| 2 | Midleaflets normal, considerable thickening of margins (5-8 mm) |
| 3 | Thickening extending through the entire leaflet (5–8 mm) |
| 4 | Considerable thickening of all leaflet tissue (>8-10 mm) |
| Calcification | |
| 1 | A single area of increased echo brightness |
| 2 | Scattered areas of brightness confined to leaflet margins |
| 3 | Brightness extending into the mid-portions of the leaflets |
| 4 | Extensive brightness throughout much of the leaflet tissue |
| Subvalvular thickening | |
| 1 | Minimal thickening just below the mitral leaflets |
| 2 | Thickening of chordal structures extending to one-third of the chordal length |
| 3 | Thickening extended to distal third of the chords |
| 4 | Extensive thickening and shortening of all chordal structures extending down to the papillary muscles |
The total score is the sum of the four items and ranges between 4 and 16.