Mitral regurgitation
LV → LA
Backward flow across the mitral valve while the LV contracts. In the same injection, LV → aorta is expected forward ejection.
The clinical video is unchanged. Colored pointers are a separate teaching layer; they mark approximate regions, not traced chamber borders.
Konishi et al., 2016 · Video S3 · 6.73 seconds. Figure 3 confirms RAO 30°. The authors report grade 3–4 MR.
First play it plain. Then tap each step.
LA: regurgitant destinationLV: injected chamberAo: forward outflow
You do not need a crisp jet
The clue may be a spreading gray cloud in the LA. Ask: “As the LV squeezes, does a second chamber fill?”
LA contrast can remain visible after systole; watch when it first enters or increases.
“Left” here means screen-left in this example, not the patient’s anatomical left. Use the actual projection and landmarks on each new cine.
The same squeeze, frozen
Large LV → smaller LV + left atrial contrast
2.53 s · before contraction
Find the large LV on screen-right and its pigtail catheter.
3.07 s · contracting
LV cavity narrows; watch the left atrial region beside the spine.
3.33 s · small LV
The second, screen-left contrast-filled chamber is the key.
Frames extracted from the original cine without altered anatomy, contrast enhancement, or generated pixels. Phase descriptions are based on visible cavity change; there is no synchronized ECG in this clip.
Build the mental map
One injected chamber. Two places to look.
On this RAO 30° display
The LV projects down and to the right. The LA is behind the LV anatomically and projects toward screen-left, near the spine. The aortic outflow rises above the LV.
First find the LV and watch it contract. Then look outside its basal border for contrast entering the LA.
Do not call every plume above the LV “MR.” Identify which chamber or vessel receives it, and when.
Projection and overlap matter. The aorta, atrium, spine, and catheter may overlap; a fixed screen direction alone is not diagnostic.
The AI confusion, cleared up
Injection site + direction + timing
Aortic insufficiency / regurgitation
Aorta → LV
Contrast leaks back through the aortic valve into the LV during relaxation. An ordinary LV injection already fills the LV, so aortic opacification from that injection does not establish AI.
10-second check
What makes this MR?
After an LV injection, contrast enters the chamber beside the spine as the LV becomes smaller.
Sources & image integrity
- Konishi et al. Severe mitral regurgitation due to mitral leaflet aneurysm, BMC Cardiovascular Disorders 16, 234 (2016). Figure 3 explicitly identifies RAO 30°; Video S3 is the corresponding LV angiogram with author-reported grade 3–4 MR. DOI · Original NCBI video stream
- © The Author(s), 2016. Licensed under Creative Commons Attribution 4.0. The video is unchanged. Teaching additions: optional SVG region pointers, extracted still frames, playback controls, schematic flow diagram, and explanatory text. The source authors have not reviewed or endorsed these additions.
- Rogers et al., 1982: comparison of conventional and axial RAO/LAO ventriculography supports the importance of projection and separating the mitral region from overlapping structures.
- Quantitative aortography for assessment of aortic regurgitation (2023) describes aortic-root contrast injection and diastolic regurgitation into the LV.
- SCAI consensus on optimal use of left ventriculography. Contrast volume, injection, catheter position, ectopy, and projection affect interpretation. This walkthrough teaches recognition, not a precise regurgitant fraction or a treatment decision.
This is a source-based educational example, not recalled examination content. It does not establish which projection or image any examination will use.
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