[Comments on the diagnostic criteria of mitral valve prolapse]

Two-dimensional echocardiography has been the reference standard for establishing the clinical diagnosis of mitral valve prolapse. Superior systolic displacement of the mitral leaflets, however, is not necessary abnormal. Whether and at what point leaflet displacement uniquely describes a pathologic process should not be accepted without defining the pattern of normal mitral leaflet motion. One should combine informations from phonocardiograms, Doppler color flow mapping and two-dimensional echocardiograms in an effort to avoid the artifice of using two-dimensional echocardiography as a categoric reference standard and to establish new clinical guidline or criteria that distinguish pathologic mitral valve prolapse from normal superior systolic displacement of the mitral leaflets. Mitral valve prolapse is a dynamic disease that results in varying clinical and morphologic presentations depending upon the degree of structural abnormality. Therefore, clinical and morphologic studies are required in not only severely symptomatic patients but also perfectly asymptomatic patients.