**2.4.8 The pattern of 'floppy mitral valve'**

10 Echocardiography – In Specific Diseases

The pattern of 'overturned mitral valve': this kind of mitral lesion resembles the mitral valve flail as general echocardiographic aspect, but in the 'overturned mitral valve' the chordae are not ruptured (Figure 8). There is only an excessive elongation of the chordae and an

Fig. 8. Transthoracic echocardiography 4 chamber view, showing the obvious prolapse of the posterior mitral leaflet, due to the 'eversion' of the mitral valve. There is a loss of leaflet coaptation due to an excessive elongation of the mitral chordae (verified in the operating

The 'pseudo-cleft' of mitral valve an obvious indentation of the border of the mitral valve, which penetrates deeply into the body of the mitral leaflet. It is pretty difficult to diagnose being visible only during the diastole and has to be integrated with the analyses of the colour Doppler in systole (Figure 9 A,B,C). It is never present as an isolated lesion; it is usually found in old mitral valve P2 prolapse. A split which resembles a pseudo-cleft

Fig. 9. (A,B,C). Diastolic transthoracic 2D and 3 D echocardiography short axis view (9A,B), showing the crack between P2 and P3 in a patient with P2 prolapse. The figure 9C shows a 3 D transesophageal representation (surgical view) of a pseudo-cleft located between the P3

**2.4.6 The pattern of 'overturned mitral valve'** 

theatre).

**2.4.7 The 'pseudo-cleft' of mitral valve** 

develops between the scallops P2 and P3 (or P1).

and P2 scallops (red arrow).

obvious prolapse of the mitral valve into the left atrium.

Represents a redundant mitral valve, usually with both leaflet prolapse. It represents an excessive valve leaflet remodelling, with a 'finger like' transformation of the valve fabrics (Figure 10).

Fig. 10. Transgastric transesophageal intraoperative view of a 'floppy' mitral valve (zoom). Notice the extensive remodelling of the leaflet fabric.
