What is the SEVERITY of Patient's MR?  

What is the ETIOLOGY of the Patient's MR?  

Select Leaflet Morphology

Select the Carpentier Classification of Leaflet Motion

Click to view ECHO image
Click to view ECHO image
Click to view ECHO image
Click to view ECHO image

Select Symptom Status

Are Any of the Following Additional Characteristics Present?
• Ejection Fraction < 0.6
• Left Ventricular End-Systolic Diameter > 4 cm
• Serial Increase in LV Size or Decrease in LV Function Over Time
• Recent-onset Atrial Fibrillation
• Pulmonary Artery Systolic Pressure > 50 mmHg

Which of the Following did Diagnostic Testing Indicate?  

Select All Criteria Typical of Severe MR That Apply to Your Patient:

Large Crescentic Orifice?

Select All Criteria Typical of Mild MR That Apply to Your Patient:

24. Hidden Severity

25. Hidden Etiology

Select Quantitative Grade That Best Describes Your Patient:

Select the Carpentier Classification of Leaflet Motion

Click to view ECHO image
Click to view ECHO image
Click to view ECHO image

Is Flail Leaflet or Tethering Present?

Welcome to ManageMR.

Use this app to help verify MR severity and etiology, and inform decisions on the feasibility of valve repair and need for referral based on severity, etiology, and other parameters.

HOW to use this app:

1. Enter your patient’s profile on this screen by answering the questions below.

2. Review full advice based on that profile on the Advice screen.

WHEN to use this app: After thorough examination of the Chronic MR patient assessing a patient's clinical presentation including symptoms, physical exam, exercise tolerance, and goals of care. In addition, ECHO findings should be reported using standardized nomenclature to further guide the surgical/interventional decision-making supported by this app.

Download a tool to help with standardized ECHO Reporting here.

Etiology is likely Secondary

Consider: Patients may reduce their activity level to avoid symptoms. It is helpful to ask the patient or their family what is the most vigorous activity s/he currently undertakes and compare that to what s/he was able to do previously.

If Secondary MR is suspected, use diagnostic testing to determine if it is of ischemic or nonischemic origin.
In making final determination of etiology, consider common pitfall: anterior leaflet override due to posterior leaflet restriction is pure secondary MR and not mixed etiology.
Etiology is likely Primary
Etiology is likely Mixed

Consider: Echo tends to underestimate MR severity in eccentric or wall-impinging jets.

Consider: Common reasons for overestimation of MR severity, such as high MR driving velocity and MR duration limited to very early or very late systole.

Severity is unknown. Further testing is advised. See Advice tab for more information.
Selected Etiology: Primary
In making final determination, also consider possibility of mixed MR due to both primary and secondary causes.
Selected Etiology: Secondary
Selected Etiology: Mixed

Severity is likely moderate based on assessment.

However, final determination should depend on integration of these parameters in conjunction with other clinical evidence including symptoms, exercise tolerance, physical exam and chamber sizes. In cases where different parameters are discordant among themselves or with clinical findings, severity is still uncertain and further testing is advised. See Advice tab for more information.

Severity is likely mild-to-moderate. Further testing is advised. See Advice tab for more information.

Severity is likely severe based on assessment.

However, final determination should depend on integration of these parameters in conjunction with other clinical evidence including symptoms, exercise tolerance, physical exam and chamber sizes. In cases where different parameters are discordant among themselves or with clinical findings, severity is still uncertain and further testing is advised. See Advice tab for more information.

Severity is moderate-to-severe. Further testing is advised. See Advice tab for more information.

Severity is likely mild based on assessment.

However, final determination should depend on integration of these parameters in conjunction with other clinical evidence including symptoms, exercise tolerance, physical exam and chamber sizes. In cases where different parameters are discordant among themselves or with clinical findings, severity is still uncertain and further testing is advised. See Advice tab for more information.