Mitral regurgitation (MR) is common. Because it is easy and quick, the regurgitant-jet area determined by color Doppler (CD) is still the most widely used approach for diagnosing the presence and severity of MR. Although CD is very sensitive and specific for MR, the method has limitations. The timing of MR, facilitated by the electrocardiogram and the color M-mode, is crucial, and using the CD criteria during the wrong part of the cardiac cycle, i.e, seeing this MR jet during the pre-ejection period (PEP), when the aortic valve is still closed, and not during the actual ejection time (ET), when the aortic valve is open, can create the impression of pathological mitral regurgitation when it does not exist. MR that occurs only during the brief PEP of 131 ± 13 ms, that does not extend into the actual ET, that does not last throughout systole, and that does not reach velocities that are associated with a true regurgitant jet is physiological and not pathological. Also, the CD morphology of this physiological MR appears as a halo around the mitral valve, without the vena contracta of pathological MR, and does not meet the other echo/Doppler criteria for significant mitral regurgitation. This physiological MR occurring only during the PEP is a normal phenomenon, not an abnormal one. Failure to make this distinction can result in misdiagnosis of the patient as having pathological MR and lead to serious mismanagement.
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