fig10

Figure 10. Two-dimensional transthoracic echocardiography in apical four-chamber view in a patient with severe MR. A relatively small size wall hugging turbulent eccentric MR jet (right arrow) consistent with mild MR is noted. If the laminar flow signals (red, left arrow) moving in the same phasic manner as the turbulent MR jet (to differentiate them from pulmonary venous inflow) are taken into account, MR severity would not be underestimated and would be correctly considered severe, as the combined turbulent and laminar flow signals virtually fill the whole LA. The laminar low velocity red flow signals also representing MR result from the high velocity turbulent flow signals striking the LA lateral wall resulting in marked reduction of their velocity. RV: right ventricle; RA: right atrium; LV: left ventricle; LA: left atrium; MV: mitral valve; MR: mitral regurgitation; TV: tricuspid valve. Reproduced with permission from Manjunath et al.^[4]