Thickened PML- 2-D PLAX

These are systolic still-frames of 2-dimensional echocardiograms in the parasternal long axis view from our patient. Image A shows a thickened posterior mitral leaflet (PML) displaced into the left atrium 3 mm beyond the mitral annulus in systole. There is failure of the leaflet edges to coapt normally, that is, the free edge of the leaflet overrides the place of the orifice during systole and excess leaflet tissue protrudes into the left atrium. Image B is an enlargement of the mitral valve. The anterior mitral leaflet is anatomically normal. The left ventricular, left atrial and right ventricular cavities are normal in size. In the real-time study that follows, note the systolic displacement, that is, posterior motion of the posterior mitral leaflet as it moves into the left atrium in systole.

Normal - 2-D PLAX

This is a systolic still-frame of a 2-dimensional transthoracic echocardiogram in the parasternal long axis view from a normal patient to contrast with our patient. The anterior and posterior mitral leaflets coapt perfectly in front of the plane of the mitral annulus, that is, towards the left ventricular apex. In the real-time study that follows, note that the two mitral leaflets coapt in front of the plane of the mitral annulus in early systole and during systole and do not bulge back into the left atrium.

Severe MVP - 2-D apical 4-chamber

This is a systolic still frame of the two dimensional echocardiogram in the apical 4-chamber view from our patient. It shows that the posterior mitral leaflet bulges back into the left atrium well below the plane of the mitral annulus. The anterior mitral leaflet, left ventricle, left atrium and right ventricle are normal. In the real-time study that follows, note that the posterior leaflet billows, or prolapses, back into the left atrium in systole.

Moderate MR - color Doppler 4-chamber

This is a systolic still-frame of a color Doppler 2-dimensional echocardiogram in the 4-chamber view from our patient. The cyan color jet of mitral regurgitation is eccentric and is directed towards the interatrial septum. It fills about one third of the left atrium. The left atrial cavity is slightly dilated. The left ventricle is normal. In the real-time study that follows, note the eccentric cyan color jet of mitral regurgitation that crosses the mitral orifice during systole and then reaches the posterior atrial wall.