Effect of Annuloplasty for Mitral Valve Prolapse: Beyond the Annulus and Leaflet

Mitral valve prolapse (MVP) is the most common cause of primary mitral regurgitation (MR), which represents leaflet or chordae elongation and is frequently accompanied by ruptured chordae. In almost all patients with this entity, annular dilatation is a common lesion. It is well known that the normal annulus has a unique saddle shape,1 but the saddle is flattened in MVP, and its dynamic characteristics are different from those of the normal annulus.2 See Article by Fukuda et al In this issue of Circulation: Cardiovascular Imaging , a group of experienced investigators led by Dr Fukuda demonstrated basal predominance of left ventricular (LV) dilatation and reduced contraction in MVP using 2-dimensional transthoracic echocardiography and speckle tracking.3 One may have suspected that the posterior leaflet would prolapse superiorly into the left atrium and potentially stretch the basal LV wall, which would then affect basal LV contraction. However, Fukuda et al3 clearly demonstrated …