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Mitral Valve Prolapse of Posterior Leaflet

Authors : Egle Rumbinaite, MD, Egle Kazakauskaite, MD.

Lithuanian University of Health Sciences
Cardiology Department.




 

Description

  • 72 years old woman came to cardiologist because of progressing dyspnea and ankle edema despite optimal heart failure treatment (including adequate dosing of diuretics).
  • She had a history of holosystolic cardiac murmur due to mitral valve prolapse, diagnosed 20 years ago.
  • At this moment surgical treatment was recommended, but she refused for many times.

Clinical case information

Parasternal long axis view: Severe dilatation of left atrium . Excentric hypertrofy of left ventricle (LV) (MMI 162.6 g/m2, RWT 0.36). Moderate LV dilatation (61 mm). Severe, excentric, anterior directed mitral valve regurgitation caused by the prolapse of the posterior leaflet (medial part of P2).

Parasternal short axis (aortic) view : Severe dilatation of left atrium . Severe, eccentric MV insufficiency directed to interatrial septum reaching pulmonary veins.

Parasternal short axis (mitral) view : Severe and eccentric regurgitation jet.

Parasternal short axis (mitral) view : Prolapse of the posterior leaflet (medial part of P2).

Apical four-chamber view : Severe dilatation of left atrium . Flail segment (P2) points towards the roof of the LA.

Apical four-chamber view : Severe, eccentric, anteriorly directed mitral valve regurgitation caused by posterior mitral leaflet prolapse.

Apical four-chamber view: Severe, eccentric, anterior directed mitral valve regurgitation caused by posterior leaflet prolapse.

Apical two-chamber view: Severe, eccentric, anterior directed mitral valve (MV) insufficiency caused posterior leaflet prolapse.

2D colour-guided CW Doppler of the regurgitant flow : High density regurgitation signal (similar to forward flow) supporting severe regurgitation.

Apical four-chamber view : Effective regurgitant orifice was computed by PISA (Nyquist, 36 cm/sec) in 1.51 cm2

Conclusion

  • Final diagnosis was severe mitral regurgitation due to posterior leaflet prolapse
  • Mitral valve prolapse (MVP) is a pathologic condition characterized hystologically by increased mucopolysaccharides .
  • Echocardiograhy shows thick and redundant leaflets and chordae with systolic displacement of leaflets into the LA in systole.
  • Many patients with MVP have slowly progressive disease leading to severe MR. A more acute course could be seen due to spontaneous chordal rupture resulting in a partial flail leaflet segment.
  • Current data shows that in adults with severe mitral regurgitation, and evidence of progressive ventricular dilatation or any reduction in left ventricular systolic function surgical intervention should be considered regardless of symptomatic status.