Grade | Definition | Valve anatomy | Valve hemodynamics* | Hemodynamic consequences | Symptoms |
A | At risk of MR | - Mild mitral valve prolapse with normal coaptation
- Mild valve thickening and leaflet restriction
| - No MR jet or small central jet area <20% LA on Doppler
- Small vena contracta <0.3 cm
| | |
B | Progressive MR | - Severe mitral valve prolapse with normal coaptation
- Rheumatic valve changes with leaflet restriction and loss of central coaptation
- Prior IE
| - Central jet MR 20 to 40% LA or late systolic eccentric jet MR
- Vena contracta <0.7 cm
- Regurgitant volume <60 mL
- Regurgitant fraction <50%
- ERO <0.40 cm2
- Angiographic grade 1-2+
| - Mild LA enlargement
- No LV enlargement
- Normal pulmonary pressure
| |
C | Asymptomatic severe MR | - Severe mitral valve prolapse with loss of coaptation or flail leaflet
- Rheumatic valve changes with leaflet restriction and loss of central coaptation
- Prior IE
- Thickening of leaflets with radiation heart disease
| - Central jet MR >40% LA or holosystolic eccentric jet MR
- Vena contracta ≥0.7 cm
- Regurgitant volume ≥60 mL
- Regurgitant fraction ≥50%
- ERO ≥0.40 cm2
- Angiographic grade 3 to 4+
| - Moderate or severe LA enlargement
- LV enlargement
- Pulmonary hypertension may be present at rest or with exercise
- C1: LVEF >60% and LVESD <40 mm
- C2: LVEF ≤60% and LVESD ≥40 mm
| |
D | Symptomatic severe MR | - Severe mitral valve prolapse with loss of coaptation or flail leaflet
- Rheumatic valve changes with leaflet restriction and loss of central coaptation
- Prior IE
- Thickening of leaflets with radiation heart disease
| - Central jet MR >40% LA or holosystolic eccentric jet MR
- Vena contracta ≥0.7 cm
- Regurgitant volume ≥60 mL
- Regurgitant fraction ≥50%
- ERO ≥0.40 cm2
- Angiographic grade 3 to 4+
| - Moderate or severe LA enlargement
- LV enlargement
- Pulmonary hypertension present
| - Decreased exercise tolerance
- Exertional dyspnea
|