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. 2002 Nov;88(Suppl 4):iv20–iv28. doi: 10.1136/heart.88.suppl_4.iv20

Degenerative mitral valve disease with emphasis on mitral valve prolapse

D Pellerin, S Brecker, C Veyrat
PMCID: PMC1876282  PMID: 12369588

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Figure 1 .

Figure 1

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Carpentier and Duran nomenclatures of the mitral valve. In the Duran nomenclature, the three scallops of the posterior leaflet are named P1, PM (middle), and P2. The anterior leaflet has only two scallops A1 and A2. The Carpentier nomenclature is described in the text. AV, aortic valve; PV, pulmonic valve; TV, tricuspid valve.

Figure 2 .

Figure 2

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Cross sectional drawing of the heart at the level of the atrioventricular valves. Dotted lines show the planes of the different views obtained during TOE or TTE studies. Left atrial appendage and aortic valve are the landmarks that must be seen or not on the image according to the view. For example, the four chamber view excludes the left ventricular outflow tract and the aortic valve. Figure 2 and table 1 are closely related. AV, aortic valve; LAA, left atrial appendage; LAX, long axis view; PLAX, parasternal long axis view; PV, pulmonic valve, TOE, transoesophageal echo; TTE, transthoracic echo.

Figure 3 .

Figure 3

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Left panel: transthoracic apical four chamber view in a patient with P2 prolapse. Although A3-A2-P1 scallops are usually seen in this view, the P2 scallop prolapse is seen behind A2. Right panel: transoesophageal four chamber view 40–50° showing the same scallops as the transthoracic four chamber view in a normal subject. TOE, transoesophageal echo; TTE, transthoracic echo.

Figure 4 .

Figure 4

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Transthoracic apical four chamber view in a patient with P2 prolapse. Left panel: on the grey scale image, the P2 scallop is visualised behind A2. Right panel: using colour Doppler flow in the same patient, there is an oblique jet of mitral regurgitation going behind the anterior leaflet which hugs the interatrial septum.

Figure 5 .

Figure 5

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Left panel: transthoracic apical two chamber view in a patient with P2 prolapse. P2 scallop is visualised behind A2. Right panel: transoesophageal intercommissural two chamber view 75–90° showing the same scallops as the transthoracic view in another patient with A2 prolapse. LAA, left atrial appendage.

Figure 6 .

Figure 6

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Left panel: transthoracic parasternal long axis (PLAX) view in a patient with P2 prolapse. In that view, the aortic valve and the ascending aorta must be well defined. Right panel: transoesophageal long axis (LAX) view 120–140° in the same patient.

Figure 7 .

Figure 7

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Transoesophageal long axis view 120–140° in the same patient as in fig 6 with colour Doppler flow showing an oblique jet of mitral regurgitation behind the anterior leaflet.

Figure 8 .

Figure 8

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Left panel: transthoracic parasternal short axis (SAX) view at the level of the mitral valve showing the six scallops of the Carpentier nomenclature in a normal subject. Right panel: transoesophageal transgastric view 0° showing the mitral valve scallops in a normal subject.

Figure 9 .

Figure 9

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Transthoracic parasternal short axis view at the level of the mitral valve in a 45 year old man undergoing chronic haemodialysis. Massive calcifications of the mitral annulus are seen, mainly in the posterior region. Mitral annular calcification is recognised as a bulky echodensity adjacent to the bases of the mitral leaflets. Calcifications can extend into the bases of the leaflets and restrict their motion. Acoustic shadowing of the left atrium in the presence of mitral annular calcification may impede the detection of mitral regurgitation on transthoracic echocardiography.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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