Mitral regurgitation jets can take many shapes
- Symmetrical
- Central
- Eccentric
The direction of the jet depends upon
- The angle of co-optation
- The plane of orientation of regurgitant orifice . It can be entirely off track with physiological mitral orifice .
- Degree of prolapse or shortening /subvalvular fusion.
- Flail valve tips can guide the jet selectively into anterior/superior or posterior aspect of LV
Rheumatic mitral valve showing poor leaflet co-optation.Patient is having significant tachycardia
Perpendicular 90 degree MR jets
In rheumatic heart disease eccentric jets are more common. In dilated cardiomyopathy MR jets are often symmetrical and central as the pathology is annular dilatation.
What are the significance of eccentric MR jets ?
- Anterior jets clinically mimic aortic stenosis as the murmur is often well conducted to neck
- Murmurs of posterior jets well conduct to axilla .
- Eccentric jets are often acute and compromise hemodynamics
- Suspect early infective endocarditis.Carefully look for vegetation.
- Eccentric jets make it difficult /risky for PTMC (Note : In Mitral stenosis + grade 1 MR with central jets one can safely do PTMC)
- Severe eccentric jets can flood one of the pulmonary veins and result in unilateral or regional pulmonary hypertension or even lobar /segmental pulmonary edema
