Diagnosing and testing for Mitral Regurgitation

Transthoracic echocardiogram (echo-Doppler of the heart). This is the main test to confirm the presence of mitral regurgitation and monitor it. It is a painless and harmless examination that studies the form and function of the heart and part of its internal structures. The images are produced by the use of ultrasound, which is not radiation and is harmless. Furthermore, it can also assess whether the regurgitation has affected the rest of the chambers.

Transoesophageal echocardiography. This examination is additional to the transthoracic echocardiographic study. It is based on ultrasound and has no radiation. A tube with a small probe at its end is inserted through the oesophagus for a more accurate image of the cardiac structures, as the heart is in contact with the oesophagus. This test is performed under light sedation to prevent discomfort, as the tube is inserted into the patient who must be accompanied and fast beforehand.  

Electrocardiogram (ECG). This test involves placing sticky pads with small devices called electrodes on the chest, arms and legs. This records the electrical activity of the heart to evaluate its rhythm.

Holter Study. This study is a non-invasive scan that allows the frequency and type of heart rhythm to be studied. Unlike an electrocardiogram, which can monitor the heart’s behaviour at any given moment, the Holter does so over the course of a full day.

Exercise echocardiography. This test is performed to find out how the heart muscle behaves during physical activity. The electrical signal of the heart and blood pressure are monitored while performing an exercise protocol on a treadmill or stationary bicycle.

Computed tomography (CT). This technique uses ionising radiation (X-rays) to obtain images of the body. It is performed before conventional surgery to evaluate the presence of calcium in the access areas to the valve. In this case, contrast administration is not necessary. In other cases, a tomography is requested to evaluate the coronary arteries, for which the administration of iodinated contrast is necessary. Evaluation of the coronary arteries is limited to people who have calcification in the arteries (due to age or cardiovascular risk factors).

Coronary angiography. It consists of inserting a plastic tube or catheter, about 2 mm in diameter, through an artery in the wrist to reach the arteries of the heart. During the procedure, contrast is injected to visualise the status of the arteries. If the procedure cannot be performed via the wrist, it can be done through a larger diameter artery via the groin. It is performed under local anaesthesia.

Chest X-ray. This test can see if the heart is enlarged, if there is any evidence of lung disease or if there is fluid in the lungs or pleurae as a result of heart failure.