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Echocardiograms and left ventricular angiograms were systematically studied in 20 consecutive patients with hemodynamically proven mitral stenosis who were in sinus rhythm. "Definite" mitral valve prolapse was present on the echograms of 9 of 20 patients (45%), while "possible" mitral valve prolapse was noted on the echograms of 7 of 20 (35%). Of the 9 subjects with definite mitral valve prolapse, 4 had angiographic evidence of this diagnosis and an identical number had mitral regurgitation; 1 patient had both prolapse and mitral regurgitation. No subject with "possible" ultrasonic prolapse or normal systolic mitral valve motion had angiographic mitral valve prolapse. It is concluded that (1) signs of mitral valve prolapse are frequently encountered on the echocardiograms of patients with hemodyn amically proven mitral stenosis who are in sinus rhythm, and (2) when stringent criteria for the echographic diagnosis of prolapse are employed, approximately 50% of affected subjects have concomitant mitral insuffi ciency.

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