Regurgitant Jet Direction in Patients With Prolapse of the Anterolateral Scallop of the Posterior Mitral Valve Leaflet

Abstract

THE ORIENTATION and direction of jets of mitral regurgitation (MR) often provide the echocardiographer with important clues regarding the precise nature of valvular pathology. For instance, a large body of literature supports the concept that prolapse of the posterior mitral valve leaflet (PMVL) results in an anteriorly directed jet of MR, whereas prolapse of the anterior mitral valve leaflet (AMVL) results in a posteriorly directed jet of MR. 1 Otto C.M. Textbook of Clinical Echocardiography. (ed 2). Saunders, Philadelphia, PA2000: 288-289 Google Scholar , 2 Steward W.J. Griffin B. Thomas J.D. Multiplane transesophageal echocardiographic evaluation of mitral valve disease. Am J Card Imaging. 1995; 9: 121-128 PubMed Google Scholar , 3 Steward W.J. Currie P.J. Salcedo E.E. et al. Evaluation of mitral leaflet motion by echocardiography and jet direction by Doppler color-flow mapping to determine the mechanism of mitral regurgitation. J Am Coll Cardiol. 1992; 20: 1353-1361 Abstract Full Text PDF PubMed Scopus (126) Google Scholar , 4 Shyu K. Lei M. Hwang J. et al. Morphologic characterization and quantitative assessment of mitral regurgitation with ruptured chordae tendinae by transesophageal echocardiography. Am J Cardiol. 1992; 70: 1152-1156 Abstract Full Text PDF PubMed Scopus (18) Google Scholar , 5 Himelman R.B. Kusumoto F. Oken K. et al. The flail mitral valve: Echocardiographic findings by precordial and transesophageal imaging and Doppler color-flow mapping. J Am Coll Cardiol. 1991; 17: 272-279 Abstract Full Text PDF PubMed Scopus (52) Google Scholar , 6 Sochowski R.A. Chan K. Ascah K.J. et al. Comparison of accuracy of transesophageal versus transthoracic echocardiography for the detection of mitral valve prolapse with ruptured chordae tendinae (flail mitral leaflet). Am J Cardiol. 1991; 67: 1251-1255 Abstract Full Text PDF PubMed Scopus (32) Google Scholar , 7 Pearson A.C. St. Vrain J. Mrosek D. et al. Color Doppler echocardiographic evaluation of patients with a flail mitral leaflet. J Am Coll Cardiol. 1990; 16: 232-239 Abstract Full Text PDF PubMed Scopus (46) Google Scholar However, as the 2 following cases show, patients with prolapse of the anterolateral scallop of the PMVL (P1) may present with posteriorly directed jets of MR, thus potentially confounding correct identification of the diseased scallop.