Carpentier’s functional classification of mitral regurgitation (MR)
Carpentier’s functional classification of mitral regurgitation (MR)
Carpentier’s functional classification of mitral regurgitation (MR), which is based on the mechanism of leaflet motion/dysfunction rather than etiology.
Here’s the breakdown:
Carpentier’s Classification of MR (by leaflet dysfunction mechanism)
- Type I – Normal leaflet motion
- Mechanism: Annular dilatation or leaflet perforation
- Leaflet motion: Normal
- Examples:
- Annular dilatation in dilated cardiomyopathy
- Endocarditis (leaflet perforation)
- Type II – Excessive leaflet motion (prolapse/flail)
- Mechanism: Chordal rupture or elongation → leaflet(s) prolapse into left atrium
- Leaflet motion: Increased
- Examples:
- Mitral valve prolapse
- Flail leaflet due to chordae rupture
- Type III – Restricted leaflet motion
- Subdivided into:
- Type IIIa – Restriction in systole & diastole
- Mechanism: Leaflet thickening, fibrosis, calcification
- Example: Rheumatic heart disease
- Type IIIb – Restriction in systole only
- Mechanism: Tethering of leaflets due to LV remodeling
- Example: Ischemic/dilated cardiomyopathy
- Type IIIa – Restriction in systole & diastole
- Subdivided into:
| Type | Leaflet Motion | Mechanism | Typical Cause |
|---|---|---|---|
| I | Normal | Annular dilatation or perforation | DCM, endocarditis |
| II | Excessive (prolapse) | Chordal elongation/rupture | MVP, flail leaflet |
| IIIa | Restricted (systole & diastole) | Leaflet thickening/calcification | Rheumatic disease |
| IIIb | Restricted (systole only) | Papillary muscle tethering | Ischemic/functional MR |
Q1. Carpentier’s classification of MR is based on:
Carpentier’s system classifies MR by leaflet motion, not etiology or severity.
Q2. Type I MR is characterized by:
Type I: normal leaflet motion, MR due to annular dilatation or perforation.
Q3. Which condition commonly produces Type II MR?
Type II MR results from excessive leaflet motion, as in MVP or flail due to chordal rupture.
Q4. Restriction of leaflets in both systole and diastole is seen in:
Type IIIa MR (rheumatic) causes restricted motion throughout the cardiac cycle.
Q5. Ischemic MR due to LV remodeling is classified as:
Ischemic/functional MR = Type IIIb (restricted in systole only due to tethering).
Q6. Which of the following best describes Type II MR?
Type II is excessive leaflet motion due to chordal rupture or elongation.
Q7. Rheumatic mitral regurgitation is typically:
Rheumatic disease causes leaflet thickening/restriction in systole and diastole → Type IIIa.
Q8. Functional MR due to dilated cardiomyopathy is most often:
Functional MR due to LV dilatation/tethering = Type IIIb.
Q9. Which of the following is an example of Type I MR?
Annular dilatation without leaflet pathology = Type I.
Q10. Flail leaflet is classified as:
Flail leaflet = excessive motion → Type II MR.
Q11. In Type IIIb MR, leaflet restriction occurs in:
Type IIIb = systolic restriction due to tethering.
Q12. Leaflet perforation in infective endocarditis produces:
Perforation with normal motion = Type I.
Q13. In MR classification, “normal leaflet motion” belongs to:
Type I = normal motion (annular dilatation, perforation).
Q14. Excessive leaflet motion best defines:
Type II MR is due to prolapse/flail from chordal pathology.
Q15. Chronic ischemic MR is usually:
Ischemic MR with tethering is Type IIIb.
Q16. Which is NOT a cause of Type II MR?
Annular dilatation → Type I, not Type II.
Q17. Leaflet tethering after MI is:
MI with LV remodeling → Type IIIb MR.
Q18. Which type of MR shows leaflet restriction in both systole and diastole?
Type IIIa is restrictive in both phases (rheumatic).
Q19. Which type of MR is associated with chordal rupture?
Chordal rupture → flail → excessive motion → Type II.
Q20. Carpentier’s classification helps primarily in:
The classification is used by surgeons to plan valve repair techniques.
