Mitral valve training › Guides › Single-scallop prolapse
Mitral valve prolapse on echo: single-scallop prolapse and MR
What to look for: One scallop billowing into the LA; a jet away from it.
Watch it in the simulator →Practise random casesCarpentier Type II: excessive motion. Prolapse (≥2 mm into the LA) or a flail edge. Jet: away from the abnormal leaflet. The classification
Key findings
- Prolapse: part of a leaflet moves ≥2 mm beyond the annular plane into the LA in systole, in a long-axis view.
- Name the scallop: the parasternal long axis and apical 3-chamber cut A2 and P2; the apical 2-chamber (bicommissural) view cuts P3, A2 and P1; parasternal short axis at the leaflet tips shows where along the coaptation line the jet starts.
- The jet runs away from the prolapsing leaflet: posterior-leaflet prolapse sends it anteriorly, along the aortic root and the atrial septum; anterior-leaflet prolapse sends it posteriorly, along the LA wall.
- Single-segment prolapse with thin leaflets (fibroelastic deficiency, usually in older patients) differs from the diffuse, thick leaflets of Barlow’s disease.
Grading the regurgitation (primary MR)
- Severe: vena contracta ≥7 mm, EROA ≥0.40 cm², regurgitant volume ≥60 ml, regurgitant fraction ≥50%. Mild: vena contracta <3 mm, EROA <0.20 cm², regurgitant volume <30 ml.
- Specific signs of severe MR: a flail leaflet or ruptured papillary muscle, a large flow convergence, and systolic flow reversal in the pulmonary veins; a dense, triangular CW signal and an E-wave-dominant inflow support it.
- Integrate several signs: no single measurement grades MR on its own.
Pitfalls
- Prolapse often leaks only from mid systole (late systolic MR): a vena contracta or PISA taken at its peak overstates it, so judge it on the regurgitant volume over the whole of systole.
- Diagnose prolapse in long-axis views (parasternal long axis, apical 3-chamber), not in the apical 4-chamber, where the saddle-shaped annulus makes normal leaflets look as if they bulge into the LA.
- Eccentric, wall-hugging jets look smaller than they are by colour area (the Coanda effect): rely on the vena contracta, the flow convergence and the other signs.
In the simulator every case varies the anatomy, the jets and the measurements: watch the lesion in Learn, then grade new cases in Practice and compare your answer with the exact one.
Related
Flail leaflet (ruptured chord) · Barlow disease (bileaflet prolapse)
Educational simulation to use under the supervision of a clinical tutor — not for clinical use.