Colour Doppler echocardiographic assessment of regurgitant flow in mitral valve prolapse.

Colour flow mapping was used to examine the pattern of regurgitant flow in 46 patients with mitral regurgitation due to mitral valve prolapse. Valve morphology was assessed from the real-time two-dimensional image and the presence of mitral regurgitation was determined from real time Doppler. On morphological criteria 11 (24%) patients had isolated or predominant anterior leaflet prolapse, 22 (48%) patients posterior and 13 (28%) patients bi-leaflet prolapse. A single regurgitant jet was detected in 43 patients (93%) and multiple jets in three (7%). The direction of the regurgitant jet was assessed in multiple views in two orthogonal planes (antero-posterior and medial-lateral) defined in relation to the mitral valve leaflets. The regurgitant jet was eccentric in the antero-posterior plane of the mitral leaflets in 40 of 45 (89%) cases and in the medial-lateral plane in 36 of 40 (90%) cases. Posterior leaflet prolapse was usually associated with antero-medially directed jets, anterior leaflet prolapse with postero-central or postero-lateral jets and bi-leaflet prolapse with predominantly postero-medial jets. In a subgroup of patients with significant mitral regurgitation and an eccentric regurgitant jet, a 'swirling' effect was produced with late systolic flow in the body of the left atrium toward the mitral valve. Colour flow mapping in patients with mitral regurgitation due to mitral valve prolapse demonstrated eccentric jets in most patients. The direction of regurgitant flow appeared to depend greatly on the dynamic anatomy of the mitral valve leaflets during systole. Although a single jet was detected in most patients, multiple jets did occur in a minority.