Echocardiographic and Pathophysiologic Insights Into Mitral Regurgitation, Mitral Annular Disjunction, and Ventricular Arrhythmias in Patients with Mitral Valve Prolapse

Mitral valve prolapse affects approximately 2.5% of the population and represents the most common cause of primary mitral regurgitation. Mitral regurgitation is related to increased leaflet size, prolapse asymmetry, long clefts, calcification, and restricted leaflet motion. Chordal abnormalities, including increased length and rupture, also play a role. Mitral valve prolapse is also recognized as an important cause of ventricular arrhythmias and sudden arrhythmic death. Patients with arrhythmic mitral valve prolapse commonly exhibit an echocardiographic phenotype characterized by thick, long mitral leaflets with multisegment bileaflet prolapse and mitral annular disjunction, with or without significant mitral regurgitation. This review discusses the pathophysiology and echocardiographic features of these abnormalities.