**2.4.4 The pattern of 'marginal prolapse'**

8 Echocardiography – In Specific Diseases

lesion has to be present in PSLAx view, otherwise, due to the shaded shape of the mitral

Fig. 4. Prolapsing mitral valve, with both leaflet involvement, shown in the 2D transthoracic parasternal long axis view. Notice the coaptation point (C) sited into the left atrium, behind

It represents the classically loss of leaflet coaptation due to ruptured tendineous chordae.

Fig. 5. Flail of the mitral valve shown in the transthoracic parasternal long axis view using real time three-dimensional technique (zoom). The classical lesion usually involves the P2 scallop of the posterior leaflet, in about 2/3 of the patients with flail mitral valve. LA = left

atrium, LV = left ventricle, pml = posterior mitral leaflet.

valve, a false diagnose of mitral prolapse may be possible.

the virtual line of the mitral annulus.

**2.4.3 The pattern of mitral valve flail** 

(Figure 5).

The pattern of 'marginal prolapse' is a rare type of mitral lesion, defined as an isolated protrusion of the free border area of one scallop, usually up to the insertion of the second degree chordae. In case of marginal prolapse, the remaining part of the surface of the scallop may be normal, without the displacement of the coaptation point into the left atrium. It is never present as isolated lesion; the marginal prolapse, as a rule, is associated with a P2 scallop prolapse of the posterior leaflet (Figure 6).

Fig. 6. Marginal prolapse of the anterior leaflet, A2 scallop (arrow), shown in 2D (zoom) and 3 D Echo. Notice the "stair like aspect" of the anterior leaflet due to the regional prolapse located between the border of the valve and insertion of the second degree chordae (usually strut chordae). This is a hidden and tricky lesion, because its presence may transform the simple mitral plasty of one leaflet, in a complex mitral repair of both leaflets.
