Left ventricular abnormalities in prolapsed mitral leaflet syndrome. Review of eighty-seven cases.

Eighty-seven patients with proven mitral leaflet prolapse were studied emphasizing cardiodynamics and left ventricular asynergy. Significant associated features were female preponderance (83%), skeletal anomalies (pectus excavatum, straight back, scoliosis, narrow antero-posterior diameter of the chest), and anomalous coronary arteries (cork-screw patterns, short left main coronary artery, anomalous origin of the coronary arteries). Prolapse of the tricuspid leaflets was found in 15 (54%) who had right ventriculography. Five types of abnormal left ventricular systolic contraction patterns were seen in 82% of the cases and these were categorized as: 1) "ballerina foot" pattern (vigorous posteromedial contraction with anterior convexity), 2) "hour glass" pattern (vigorous ringlike contraction involving the middle portion of the left ventricle), 3) inadequate long axis shortening, 4) posterior akinesis, and 5) cavity obliteration pattern. The over-all left ventricular performance was normal generally, as indicated by normal values for functional parameters including left ventricular end-diastolic pressure, cardiac index, ejection fraction, contractility index (stroke work per end-diastolic volume) and pre-ejection period/left ventricular ejection time (PEP/LVET). The myocardial component of the syndrome of prolapsed mitral (and/or tricuspid) leaflets is expressed as asynergistic patterns of ventricular motion and usually does not impair over-all cardiac dynamics.