Evaluation of mitral valve prolapse by four-dimensional echocardiography

To observe the stereoscopic structure and the motion of the prolapsing mitral valve and its regurgitant jet in comparison with the normal mitral valve, four-dimensional (or dynamic three-dimensional) echocardiography of mitral valve apparatus was obtained in 20 patients with mitral valve prolapse and 10 unaffected subjects by use of transthoracic and transesophageal methods. The normal mitral valve apparatus has a consistent saddle-shaped configuration, with its anterior and posterior high points located near the aortic root and posterior left ventricular wall, respectively, and its low points located medially and laterally. In mitral valve prolapse, the spatial relation of mitral leaflets and anulus can be observed in four dimensions either from the left ventricle toward the left atrium or from the left atrium toward the left ventricle; the position, size, shape, motion, and extent of functional abnormality of the prolapsing mitral valve were clearly displayed. On the long-axis view of the left ventricle and the apical four-chamber view of four-dimensional echocardiography, the part of prolapsing mitral valve that protruded into the left atrium appeared as a spoon-like depression. We also obtained four-dimensional images of regurgitant blood flow to observe the stereoscopic view of blood flow column and its cross-sectional area, spatial position, and dynamic changes. This technique is of great value in evaluating patients with mitral valve prolapse, increasing the diagnostic sensitivity and specificity, and giving assistance to the surgeons in making preoperative therapeutic decisions and assessing the intraoperative and postoperative results.