**2.4.5 The 'undulating mitral valve'**

The 'undulating mitral valve' is usually a redundant mitral valve, with excessive tissue, presenting with diastolic fluttering of the free border of both leaflets. In most cases, the prolapsing score is high, approximately 8/8 and as a rule, for the surgeon, it means a complex mitral repair. It is important to underline that the border or a normal mitral valve opens in a linear manner, without diastolic fluttering of the edge.

Fig. 7. Undulating mitral valve. TEE deep trans-gastric short axis view. Notice the undulating aspect of the free borders of the leaflets (much more evident on moving pictures).

The Degenerative Mitral Valve Regurgitation:

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

Notice the extensive remodelling of the leaflet fabric.

**2.4.9 The pattern of 'billowing mitral valve'** 

the left ventricular cavity.

(Figure 10).

From Geometrical Echocardiographic Concepts to Successful Surgical Repair 11

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

Fig. 10. Transgastric transesophageal intraoperative view of a 'floppy' mitral valve (zoom).

Is represented by the protrusion of the leaflet body into the left atrium cavity. As a rule, the coaptation point still remains into the left ventricular cavity (Figure 11). associated with

Fig. 11. Billowing mitral valve. PSLAx view of transthoracic exam showing the protrusion of the posterior leaflet (P2 scallop) into the left atrial cavity. Often the mitral regurgitation may be absent or mild due to a pretty good coaptation, with the coaptation point still sited into

mitral insufficiency, but it is important to indicate it to the surgical team.
