Colour Doppler echocardiographic assessment of regurgitant flow in mitral valve prolapse

Colour flow mapping was used to examine the pattern of regurgitantflow in 46 patients with mitral regurgitation due to mitralvalve prolapse. Valve morphology was assessed from the real-timetwo-dimensional image and the presence of mitral regurgitationwas determined from real time Doppler. On morphological criteria11 (24%) patients had isolated or predominant anterior leafletprolapse, 22 (48%) patients posterior and 13 (28%) patientsbi-leaflet prolapse. A single regurgitant jet was detected in43 patients (93%) and multiple jets in three (7%). The directionof the regurgitant jet was assessed in multiple views in twoorthogonal planes (antero-posterior and medial-lateral) definedin relation to the mitral valve leaflets. The regurgitant jetwas eccentric in the antero-posterior plane of the mitral leafletsin 40 of 45 (89%) cases and in the medial-lateral plane in 36of 40 (90%) cases. Posterior leaflet prolapse was usually associatedwith antero-medially directed jets, anterior leaflet prolapsewith postero-central or postero-lateral jets and bi-leafletprolapse with predominantly postero-medial jets. In a subgroupof patients with significant mitral regurgitation and an eccentricregurgitant jet, a ‘swirling’ effect was producedwith late systolic flow in the body of the left atrium towardthe mitral valve. Colour flow mapping in patients with mitral regurgitation dueto mitral valve prolapse demonstrated eccentric jets in mostpatients. The direction of regurgitant flow appeared to dependgreatly on the dynamic anatomy of the mitral valve leafletsduring systole. Although a single jet was detected in most patients,multiple jets did occur in a minority.