Utility of three-dimensional transesophageal echocardiography: anatomy, mechanism, and severity of regurgitation in a patient with an isolated cleft posterior mitral valve.

Echocardiographic assessment of a 72-year-old woman revealed a posterior mitral valve prolapse with an unusual central regurgitation jet. The use of three-dimensional (3D) transesophageal echocardiography elucidated the mismatch between morphologic and color Doppler echocardiographic findings: There was a cleft in the posterior mitral valve in addition to the posterior mitral valve prolapse. This case illustrates that the use of high-quality real-time 3D transesophageal echocardiography (including 3D color Doppler) facilitates the understanding of the anatomy and the mechanism and severity of regurgitation in complex mitral valve pathology and is clearly superior to two-dimensional transesophageal echocardiography alone.