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Updated: Jul 13, 2025

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Commissure leaflet prolapse closely mimics anterior mitral leaflet perforation in 2-D image of transesophageal
Kazuto Miyata1, Sayaka Shigematsu2, Naoki Miyayama2
1Department of Anesthesia, New Heart Watanabe Institute, Hamadayama 3-19-11, Tokyo, Suginami-Ku, Japan. kmiyata0410@gmail.com.
Background:
Precise diagnosis of mitral valve regurgitation is challenging, particularly for distinguishing between commissure leaflet prolapse and anterior leaflet perforation, based exclusively on 2-dimensional (2-D) imaging by transesophageal echocardiography. CASE 1: Two mitral regurgitation jets suggesting anterior leaflet perforation, but no regurgitation orifices, were observed in the mid esophageal (ME) 4-chamber view. Multiple 2-D and 3-dimensional (3-D) images revealed prolapse of the anterior (A3) leaflet and posterior commissure, not anterior leaflet perforation. CASE 2: A regurgitation jet suggesting an anterior leaflet prolapse with a regurgitation orifice was observed in ME long-axis view. Multiple 2-D and 3-D images showed only anterior commissure prolapse, but no signs of anterior leaflet perforation.
Conclusions:
A regurgitant jet caused by commissure leaflet prolapse closely resembles anterior leaflet perforation in 2-D imaging. Careful evaluation of multiple 2-D and 3-D images, as well as of the regurgitation orifices, is crucially important for making an accurate diagnosis.
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