Fig. 4. Systolic frame of the parasternal long-axis (PLAX) shows significant prolapse (>2 mm) of both mitral valve leaflets above the mitral annular plane. (Please see companion DVD for corresponding video.)

Caveats about detection of mitral valve leaflets include mistaking myxomatous or floppy valves for vegetations or masses (see Chapter 19, Fig. 11). MR may be absent at rest, but can be precipitated by exercise in some patients with MVP, so exercise stress echocardiography may be useful for diagnosis.

Although echocardiography is useful in defining MVP, the MVP syndrome includes associated clinical features and auscultatory findings. Furthermore, the pathology underlying the primary MVP may also affect other intracardiac valves, and assessment for concomitant prolapse of the tricuspid, pulmonary,


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