Cardiovascular Imaging

Mitral valve prolapse

(MVP), systolic displacement of a portion or all of one or both mitral leaflets beyond the mitral annulus into the left atrium during systole. The prolapse usually occurs in mid or late systole and may be accompanied by various degrees of mitral regurgitation. The primary pathology is myxomatous degeneration of the mitral valve; there is variable degeneration of the leaflets, chordae tendinae and annulus. Flail leaflet with severe regurgitation is a complication of chordal rupture. The posterior leaflet is more frequently involved. Other valves, particularly the tricuspid valve, may be affected. MVP most frequently occurs as an isolated entity but has also been encountered as a component of several syndromes including Marfans syndrome, Ehlers Danlos syndrome, osteogenesis imperfecta, and pseudoxanthoma elasticum. MVP may also occur from ischaemic papillary muscle dysfunction. The major clinical feature of the mitral valve prolapse syndrome is mid to late systolic clicks identified with auscultation of the mitral valve.

Echocardiography is usually employed for diagnosis. M-mode echocardiography shows posterior movement of the posterior or both leaflets of the mitral valve in systole. Two-dimensional echocardiography displays one or both leaflets prolapsing behind the mitral annulus and into the left atrium in systole. Other features are thickened leaflets and enlarged mitral annulus. Doppler echocardiography may demonstrate mitral regurgitation and can estimate its severity. Left ventriculography in the right anterior oblique plane demonstrates scalloped configuration of the posterior leaflet in systole and billowing of all or portions of the leaflet into the left atrium in systole.

CBH