Billowing, floppy, prolapsed or flail mitral valves?

摘要: More than 2 decades ago the auscultatory features of a late systolic murmur and non-ejection click were shown to originate at mitral va1ve.i Left ventricular cineangiocardiography confirmed that murmurs indicative mild regurgitation demonstrated “massive dilatation,” “aneurysmal protrusion,” “billowing” or “ballooning” posterior leaflet.2g3 Later studies showed anterior leaflet was also involved. In 1966, Criley et al4 clarified cineangiocardiographic appearances introduced term prolapse. Mitral valve prolapse (MVP) is now widely used regardless whether anomaly anatomically mild, echocardiographically demonstrable, functionally normal clinically silent. This has contributed general confusion, it crucial for terms billowing, floppy, flail be defined. Such definitions should based essentially on functional anatomic, pathologic, characteristics mechanism. Auscultatory, echocardiographic, other clinical then correlated with probable anatomy. It is, after all, anatomy mechanism we attempt assess by all invasive noninvasive investigations. We recently expressed view5 concept propounded French cardiac surgeon, Alain Carpentier, defines essential differences between billowing. this context Carpentier restricts use failure edges appose normally. partial loss apposition may occur without abnormal billowing bellies leaflets, regurgitation, albeit even minimal, will inevitably result. implies function which in fact, both appropriate correct. Any valve, provided there not hole cleft leaflet, remains competent while sustained coaptation edges. Prevention if 1 more leaflets are fibrosed retracted. If size larger, result Based Carpentier’s understanding MVP, consider following terms, reflect anatomy, clarify much current confusion. The billow slightly, closure, into left atria1 cavity (Fig. 1A). Exaggeration