2. REPRESENTATIVE CASES

2.1. Type II and III

Fig 12: Image 1 and 2: 3C and 4C views. Showing a displacement of 7 mm of the posterior...

Fig 13: 3C view. Posterolateral disjunction, type III. Mitral valve disjunction with...

Fig 14: Showing a type II inferior disjunction (2 mm) in a 2C-view.

Fig 15: Image 1 to 5: 4C, 3C, 2C, 2C and 3C view respectively. Dysplastic mitral valve...

2.2. Radiological associations

• Mitral valve elongation
  

  Fig 16: Image 1 to 4: Posterolateral disjunction of 11.5 mm in 3C view and...
• Mitral valve thickening Mitral thickening is usually secondary to concomitant myxomatous degeneration.
  

  Fig 17: Image 1 (2C view) shows mitral leaflet thickening (marked with a yellow arrow)....
   
• Subvalvular apparatus abnormalities Alterations in the subvalvular apparatus could condition the outcome of surgical repair, although their influence remains uncertain.
  

  Fig 18: Images 7 (4C) and 8 (short axis) show fragmented / duplicated papillary muscles...
   
• Mitral valve prolapse (MVP) Mitral prolapse is defined as a superior displacement of the mitral valve of at least 2 mm during systole. MVP is a functional characteristic with consequent mitral regurgitation. In patients with myxomatous mitral valve disease and mitral valve prolapse, MAD is common and, therefore, in these patients it is very important to carefully examine the posterior annulus for disjunction.
  

  Fig 19: Image 1: 2C-view. Anterior (9.7 mm) and posterior (10.8 mm) leaflet prolapse....
• Myxomatous degeneration if mitral leaftlets Myxomatous degeneration of the mitral valve consists of a thickening of at least 5 mm during diastole.The causal relationships between myxomatous MVP, and the mitral annulus are not yet fully understood. However, it is evident that the presence of a MVD in patients with MMVD has both functional and clinical implications and contributes to an increased incidence of ventricular arrhythmia and sudden cardiac death.
  

  Fig 20: Images 1 and 2 (sequential 2C-views) and image 3 (4C view) show a myxomatous...

  In MVD associated with myxomatous degeneration of the mitral leaflets, there is a clear separation in the atrioventricular groove possibly, in part, also due to leaflet thickness.

• Mitral valve regurgitation
  

  Fig 21: Image 1: Important mitral regurgitation jet is displayed.
• Late enhancement MVD is an independent risk factor for arrhythmias. Late gadolinium enhancement (LGE), is frequently seen in patients with mitral prolapse, particularly in the papillary muscles or inferior basal wall. Areas of LGE correlate with scars observed in pathological specimens, as well as with arrhythmia origins identified in electrophysiological studies.

  Therefore patients with LGE areas are associated with an increased risk of arrhythmias and arrhythmic MVP may also have more diffuse fibrosis, identified on CMR by a larger extracellular volume.

  Characteristically, ventricular extrasystoles originating in the papillary muscles may occur in MVP and MVD.

  

  Fig 22: Images 1 (Short-axis view) and 2 (2C view) show myocardial enhancement in the...

2.3. Mimics and pitfalls

• Mitral valvular prosthesis
  

  Fig 23: Image 1 and 2: 4C views. The images show an apparent separation between the...
• Redundant valvular leaflet
  

  Fig 24: Image 1 shows elongation and marked thickening of the mitral valvular...