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European Heart Journal 1981 2(2):147-154;
Copyright © 1981 by the European Society of Cardiology.
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© 1981, by The European Society Of Cardiology

M-mode and cross-sectional (2D)echocardiograms in the diagnosis of mitral valve prolpase

A. K. BROWN and V. ANDERSON

The cardiac Investigation Department, Royal Lancaster Infirmary, Lancaster U.K.

Received 23 October 1980; revised 4 December 1980; .

Requests for reprints to: Dr Allen K.Brown, The Cardiac Investigation Department, royal Lancaster Infiramary, Lancaster, U.K.

Abstract

Forty-nine patients were studied to assess the value of M-mode and cross-sectional echocardiography in the diagnosis of mitral valve prolapse. There were 20 normal subjects and 29 patients with clinical and phonocardiographic evidence which suggested prolapse. Using an arbitrary line connecting the base of the anterior and posterior leaflets at their attachment to the atrioventricular junction, 22 of the 29 patients had abnormal arching of the mitral leaflets into the left atrium on cross-sectional echocardiograms (CSE); this was not seen in the normal subjects. There were 15 patients with double leaflet prolapse, five with lone anterior and two with lone posterior leaflet prolapse. M-mode recordings failed to show prolapse in six of the 22 patients with positive CSE but showed prolapse in one patient with an inadequate cross-sectional echocardiogram. The difficulty in demonstrating prolapse on M-mode was caused by multiple systolic echoes in four subjects, and poor separation of the posterior leaflet from the posterior left ventricular wall echoes in two subjects. The anterior leaflet was well seen on CSE with long axis parasternal views but the posterior leaflet could not be seen on the long axis view in 13 of the 29 subjects in the abnormal group; short axis four chamber views from the apex allowed definition of the posterior leaflet in nine of these 13 patients.

We conclude that CSE is better than M-mode echocardiography and should be used in conjunction with it for the diagnosis of mitral valve prolapse. Superior arching of the mitral leaflets into the left atrium is the characteristic feature, and long axis parasternal views should be supplemented by short axis four chamber apical views.

Key Words: M-mode and 2D echocardiography • mitral valve prolapse.


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