Two-Dimensional Echocardiographic Morphology in Mitral Valve Prolapse

In order to classify mitral valve prolapse (MVP) according to two-dimensional echocardiographic morphology, the clinical and echocardiographic findings of 80 patients (50 girls and 30 boys) aged 9 months-19 years prolapse (MVP) were evaluated. Based on the parasternal long-axis view, MVPs were classified according to the appearance of mitral leaflets (straightened, bowing) and the position of the coaptation point of the leaflets with respect to the annular plane; 6 distinct morphological subsets were thus identified. Relations between symptoms, physical findings, ECG, x-ray, echocardiographic findings and the morphological groups were analysed, the frequency distribution of mitral regurgitation in each subset was determined. Symptoms were more common in the straightened leaflet group (p=0.02). There were no significant differences between the morphological groups regarding the frequency of arrhythmia, ST segment and T wave changes on ECG. Left atrial and left ventricular enlargement on M-mode echocardiography were more common in the bowing and billowing leaflet groups (p<0.02). The prevalence of mitral regurgitation on CW and colour Doppler echocardiography was 32.1%, 62.9% in the straightened, bowing, billowing leaflet groups, respectively. Mitral regurgitation, a major determinant of the course and prognosis of MVP, was significantly more common in the bowing and billowing leaflet groups (p=0.05), in subsets with superior displacement of the coaptation point (p=0.002) and in those showing disruption of leaflet edge apposition (p>0.0001).