fig8

Figure 8. Two-dimensional transthoracic echocardiography in apical four-chamber view in a patient with severe MR. The vertical arrow points to a large flow acceleration, and the distance between the two + signs represents the vena contracta width, which measures 1.13 cm, indicative of severe MR. Not only the turbulent flow signals (right arrow in LA) but also the accompanying laminar flow signals (red, left arrow in LA) moving in the same phase as the turbulent flow signals represent MR. Thus, MR flow signals practically completely fill the LA, indicative of torrential MR. MR severity would have been underestimated if the red laminar signals were not taken into account. LV: left ventricle; LA: left atrium; MR: mitral regurgitation. Reproduced with permission from Manjunath et al.^[4]