A Method for the Assessment of Mitral Valve Regurgitation Grade and Severity

Reida M. El Oakley1, *
, Abdelkader Almanfi2

1 Department of Medicine, The Libyan International Medical University, Kairouan St, Benghazi, Libya
2 Department of Medicine, Structural Heart Program, The daCare Regional Medical Centre, Appleton, WI, USA

© 2020 El Oakley and Almanfi.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Medicine, The Libyan International Medical University, Kairouan St, Benghazi, Libya; Tel: +966542998305; E-mail:



Previous grading and severity scores of MR were based on a mix of objective echocardiographic data and subjective findings such as the presence or absence of symptoms. There is a need for a grade - and a severity -score for Mitral Valve Regurgitation (MR) that is based purely on objective findings and avoids the ambiguity of labelling the same degree of MR differently according to symptoms severity and/or the underlying etiology.


We reviewed published reports regarding MR severity and grades and provided a method for the assessment of MR severity and grades based purely on objective data regardless of the symptom(s) and/or underlying cause(s) of MR. Objective Echocardiographic and/or Cardiac Magnetic Resonance (CMR) findings of Vena Contracta (VC) size in cm2, Effective Regurgitant Orifice area (ERO) in cm2, Effective Regurgitant Volume (ERV) in mls/beat, and Regurgitation Fraction (RF) as a percentage of the left ventricular stroke volume, were given a score value of A, B, C or D with increasing severity, thus ranging from the mildest degree“A” to most severe “D”.


As summarized in Table 4, MR severity ranged between 4 “As” to 4 “Ds”. Further elaboration regarding the parameter(s) most severely affected may be added to the score value, e.g., scoring MR with a VC = 0.60 cm2 associated with EROA = 0.4cm2, ERV = 60mls and RF = 45% will be 2D (EROA and ERV) MR, thereby avoiding overlap between various degrees of MR and/or further data manipulation to make other parameters fit one grade of MR or another.


Applying this scoring/grading system to Echocardiographic and/or CMR studies of patients with mitral valve regurgitation will enhance our endeavors to use a clear and unified language regarding MR severity without compromising the quality of Echocardiographic or CMR findings and/or reporting.

Keywords: Mitral, Valve, Regurgitation, Severity, Grade, Score, Transcatheter, Repair, Replacement.