Anterior mitral valve prolapse

Images by Genevieve Carbonatto

Off axis PLAX  left ventricle, (LV) in a “Cavus Excavatum” chest with a prolapse of the anterior leaflet of the mitral valve, (MVP).

Off axis PLAX in a “Cavus Excavatum” chest with colour across the mitral valve, (MVP).  Note that the colour jet is directed posteriorly with an anterior leaflet MVP.

Apical 4-chamber view.  Mitral valve prolapse should not be diagnosed on an Apical 4-chamber only due to the saddle shape of the mitral valve, even a normal valve may appear to be prolapsing.
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Measure LVOT vti using pulsed wave (PW) Doppler. The LVOT flow is reduced in this case.  Normal LVOT  vti = 17 – 24cm. in setting of normal ejection fraction.  Normal ejection fraction (EF%) does not equal normal cardiac output.

Colour flow across the tricuspid valve in the Apical 4-chamber view. Colour scale is at the highest for image depth.  Colour gain is maximised then just reduced slightly to display colour jet.
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Continuous wave (CW) Doppler across the tricuspid valve. Measure peak velocity at the peak of the waveform. Ensure Doppler line of sight is parallel to flow, otherwise, peak velocity will be under-estimated.

Apical Long axis ( Apical 3-chamber view) of left ventricle.

Apical 2-chamber view with posterior tilt.   Colour across the mitral valve demonstrates two moderate jets of posteriorly directed mitral regurgitation, (MR) consistent with reduced LVOT flow. The descending thoracic aorta can be seen in long axis posterior to the left atrium (LA).

 

 

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