Mitral Valve Anatomy In Mitral Regurgitation

Mitral regurgitation is commonly due to degeneration of the mitral valve leaflets. While performing an echocardiogram, it is important to identify the valve abnormality resulting in MR. They can be of the following types

1. ‘Billowed’ mitral valve - Here, a small part of the mitral valve leaflet protrudes into the left atrial cavity, but the coaptation of the leaflets remains intact. At most, it can only result in mild MR.

2. Mitral valve prolapse - Ideally recognised in parasternal long axis view, it is commonly due to myxomatous degeneration (called Barlow’s syndrome). The leaflets (any one or both) protrude back into the left atrium in mid to late systole. It is a common cause for mitral regurgitation. Here, the mitral valve leaflet tips are directed towards the LV, as opposed the LA (seen in flail leaflet)

Here is a video demonstrating MVP with chordal rupture and myxomatous leaflets -





3. Floppy mitral valve - Here the valve is thickened (to >5mm in diastole) due to redundant tissue

4. Flail leaflet - This is due to rupture of the chordae tendinae, which results in the leaflet ‘flailing’ about during cardiac contraction and relaxation. It results in acute severe MR, and requires urgent treatment as there is a high risk of developing pulmonary edema. It commonly involves the posterior mitral valve leaflet in >70% cases. On echo, the mitral valve leaflet tip is directed towards the left atrium.


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