[Angiographic diagnosis of mitral valve prolapse: errors and limitations]

In order to assess the reliability of some recently proposed methods for angiographic diagnosis and quantification of mitral valve prolapse (MVP), the left ventricular silhouettes obtained by cineangiography in 48 patients with typical auscultatory and M-mode MVP findings were examined. The following methods were tested in 40 angiographic studies that were found to be of good technical quality: method of Farry et al. (1975), of Smith et al. (1978), of Engel et al. (1978), of Spindola-Franco et al. (1979). In 23 cases a two-dimensional echocardiographic study was also performed and Engel's angiographic criteria were utilized to quantify the MVP. The angiographic and echocardiographic data were correlated in 13 cases in which it was possible to obtain both good quality echocardiographic and adequate angiographic (end-systolic identification of the two mitral valve commissures) studies. The following conclusions can be drawn: a correct angiographic quantification of the extent of bulging requires both end-diastolic and end-systolic identification of both anterolateral and posteromedial commissures; in spite of the good quality of the angiographic studies a correct end-systolic identification of the two commissures is obtainable in less than 50% of cases, which obviously restricts considerably the applicability of any objective method; among the tested angiographic methods only the Engel's method (evaluation of the distance between the plane of the mitral valve and the most protruding point of the prolapsed leaflets) showed a satisfactory diagnostic sensitivity (75% in RAO projection, 89.5% LL projection, 100% utilizing both projections); angiography is not suitable for a quantitative classification of the MVP in mild, moderate and severe forms; such a possibility, on the contrary, seems to be offered by two-dimensional echocardiography provided that Engel's angiographic are adopted.