No abstract

PurposeFlail mitral leaflet has been well identified by two-dimensional echocardiography (2-D Echo). Direction of the mitral regurgitation (MR) jet on color Doppler has been used to distinguish this condition from other causes of MR. We describe an additional color flow Doppler manifestation which can help in confirming the diagnosis: local systolic turbulence centered at the site of the flail leaflet itself.MethodsFourteen patients had flail mitral leaflet on 2-D Echo (Table). The diagnosis was based mainly on lack of normal mitral leaflet apposition in systole, with abnormal systolic pointing of the flail component of the leaflet into the left atrium. ResultsAll patients had moderate or severe MR. On 2-D color Doppler Echo, intense local turbulence with prominent yellow-cyan components centered at the site of the flail leaflet was noted in 11 out of the 14 patients (79%) with flail mitral leaflet. All 14 patients exhibited an eccentric systolic jet which was in a direction opposite to that of the flail mitral leaflet. The intense focal turbulence could be distinguished spatially from the vena contracta of the MR jet, on frame-by-frame viewing. In 20 other patients with MR but no flail leaflet, the color flow Doppler pattern appeared as a smooth turquoise or blue stream, often admixed with small elements of orange and yellow; no localized turbulence was noted in any of them.ConclusionsThis new color flow Doppler sign of flail mitral leaflet may help in its echocardiographic diagnosis, when the 2-D appearances of flail leaflet are not clear due to poor acoustic windows or inconspicuous component of a small partly flail mitral leaflet.

We describe a new échocardiographie abnormality, prolongation of the mitral DE interval, in 17/22 patients with cor pulmonale. The mitral DE interval was 0.067 ± 0.008 s (mean ± SD) in 50 age-matched controls, and 0.114 ± 0.021 s in the 22 cor pulmonale patients. ECG evidence of right ventricular hypertrophy was present in only 11/22 patients. Six patients with the most severe cor pulmonale had the longest DE intervals, with complete or near complete suppression of early diastolic mitral valve opening in 4. Of these 6 patients, 4 died within 3 months, but none of the other 16 died in this period. The pathogenesis of this échocardiographie abnormality is uncertain, but abnormal ventricular interdependence resulting in leftward (posterior) septal shift may be a key factor. Close attention to the DE phase of mitral motion may provide useful diagnostic and prognostic information in patients with suspected cor pulmonale.