COLOR DOPPLER GRADING OF MITRAL REGURGITATION ON THE BASIS OF A 4-DIMENSIONAL APPROACH - A PERTINENT ANSWER TO CLINICAL NEEDS

Color Doppler grading of mitral regurgitation suffers from some discre pancies when compared with invasive procedures, and does not completel y fulfill the needs of the clinicians for decision making. When studyi ng the jet in the receiving chamber, its spatial three-dimensional con figuration should be taken into account by the calculation of a three- dimensional Doppler index of severity. This should be sufficient with most regurgitations without temporal variations, and particularly with severe grades. On the other hand, when temporal variations occur duri ng systole, the grading relying on measurements of maximal jet areas, frequently used in many studies in the literature, only represents the regurgitant jet at a given period of systole, and is not representati ve of the regurgitant phenomenon throughout systole. It may entail err ors, particularly for mild and moderate grades. In these cases, tempor al information should be added and indexes weighted, in order to provi de a pertinent four-dimensional grading. This updated grading reduces the overlap of values. Thus, it better fulfills the needs of clinician s, by providing a reliable discrimination between each grade.