Images in cardiovascular medicine. Leaflet-dependent spectrum of regurgitant jet in mitral valve prolapse.

A 79-year-old man was being evaluated for possible mitral valve repair for increasing mitral regurgitation. Transesophageal echocardiography with color flow Doppler showed left atrial enlargement, mitral valve prolapse, and spontaneous changes in the direction and configuration of regurgitant jets (during the same imaging study) determined by which leaflet prolapsed into the left atrium during systole. A, Mitral valve prolapse (white arrows) involving both leaflets. B, Centrally located mosiac jet (white arrowheads) resulting from the bileaflet prolapse shown in A. C, Eccentric, laterally located mosaic jet along the lateral wall of the left atrium (white arrowheads) associated with prolapse of only the anterior mitral leaflet. D, Eccentric, medially located mosaic jet (white arrowheads) along the posterior wall of the aorta associated with prolapse of the posterior mitral leaflet. LA indicates left atrium; LV, left ventricle; and AO, aorta.