Different etiologies and formation mechanisms can occur in MVA. Echocardiography plays a fundamental role, providing meticulous examination of the mitral valve anatomy and flow. Unlike standard recommendations, clinical management is possible, and diagnosis does not imply immediate surgical correction.

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Chronic obstructive pulmonary disease (COPD), considered a global epidemic, is currently the fourth leading cause of death worldwide. 1,2 This public health problem is responsible for substantial morbidity and mortality, as well as high health care costs. Although defined as an inflammatory process that results in airway obstructions and parenchymal destruction, changes in pulmonary vessels are an important component of COPD and can cause right ventricular (RV) dysfunction, even in less severe patients. 3 Despite their prognostic implications, 4 changes in RV function are often overlooked in routine clinical assessments. In addition, RV analysis with conventional echocardiography is technically challenging in these cases, either due to complex geometry or the pulmonary hyperinflation that occurs in COPD patients. However, three-dimensional echocardiography and myocardial deformation indices Int J Cardiovasc Sci. 2022; [online].ahead print, PP.0-0

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