Severe MR suggested

• Closure drift of the AV at the end systole in the presence of normal LVEF.
  
• ↑ LA/LV diameter; Flailed MV leaflet; papillary muscle rupture.
  
• CW: ↑↑ signal intensity/density and presence of “v” wave cut off sign.
  
• MV VTI/LVOT VTI ≥ 1.3.
  
• MR Color flow area averaged/LA Area averaged in 3 planes (mild <20%, moderate 20–40%, severe >40% mosaic part of a jet only).
  
• Color eccentric MR jet reaching posterior wall of LA and entering into RUPV and LUPV.
  
• Increased E velocity (≥1.4 m/sec native, >2.0 m/sec prosthetic) without increase of DT (deceleration time).

Severe MR most likely ruled out

• Presence of significant spontaneous contrast in LA.
  
• A > E in mitral inflow pattern.

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