ABC Imagem Cardiovasc. 2026; 39(2): e20260024
My Approach to Assessing Mitral Regurgitation with Splay: What Does It Mean for Severity?
DOI: 10.36660/abcimg.20260024i
Abstract
Echocardiographic assessment of mitral regurgitation (MR) is multiparametric and often challenging. The artifact known as splay has been described as an additional tool for estimating the severity of regurgitation. The term refers to a side-lobe artifact that forms a horizontal arc on color Doppler imaging. This same phenomenon can also be observed in other valvular heart diseases, such as aortic regurgitation. In 2020, Wiener et al. reported that splay was present in 81% of cases of significant MR, reaching 93% in eccentric jets, whereas the prevalence was only 16% in mild MR. Verbeke et al. associated the artifact with larger regurgitant volumes. A splay width greater than 29 mm was identified as an independent predictor of adverse cardiovascular outcomes. Although its presence alone does not denote severe MR, splay acts as a red flag, suggesting that regurgitation may be greater than it appears and indicating the need for careful reassessment of the transthoracic echocardiogram or, possibly, complementary transesophageal echocardiography. Further evidence and systematic evaluations are needed to investigate the best strategy for incorporating these data into the multiparametric approach to MR.
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