Correspondence

Repair of Mitral-Valve Prolapse

N Engl J Med 2010; 362:857March 4, 2010

Article

To the Editor:

In the review article by Verma and Mesana (Dec. 3 issue),1 mitral-valve prolapse is defined as the displacement of some portion of one or both mitral-valve leaflets into the left atrium during systole. This term was introduced in 1966 by Criley et al.2 and has been frequently used as a synonym for “billowing mitral leaflet,” which was used by Barlow et al.3 to describe the same condition. Unfortunately, imprecise terminology may have important implications for mitral-valve repair. According to Carpentier,4 the term “prolapse” should be reserved to indicate that the free edge of the leaflet protrudes beyond the mitral annulus level during systole, whereas the term “billowing” should be used when the leaflet body bulges into the left atrium, overriding the mitral annulus plane and usually maintaining the free edge of the leaflets on the ventricular side,5,6 although the two conditions may coexist. Agreement on a common terminology may allow a better anatomic correlation of the echocardiographic findings, which may result in improved treatment for patients.

Alberto Bouzas-Mosquera, M.D.
Nemesio Alvarez-Garcia, M.D.
Jesus Peteiro, M.D., Ph.D.
Hospital Universitario A Coruña, A Coruña, Spain
aboumos@canalejo.org

No potential conflict of interest relevant to this letter was reported.

6 References

1. 1

   Verma S, Mesana TG. Mitral-valve repair for mitral-valve prolapse. N Engl J Med 2009;361:2261-2269
   Full Text | Web of Science | Medline

2. 2

   Criley JM, Lewis KB, Humphries JO, Ross RS. Prolapse of the mitral valve: clinical and cine-angiocardiographic findings. Br Heart J 1966;28:488-496
   CrossRef | Web of Science | Medline

3. 3

   Barlow JB, Bosman CK, Pocock WA, Marchand P. Late systolic murmurs and non-ejection (“mid-late”) systolic clicks: an analysis of 90 patients. Br Heart J 1968;30:203-218
   CrossRef | Web of Science | Medline

4. 4

   Carpentier A. Cardiac valve surgery -- the “French correction.” J Thorac Cardiovasc Surg 1983;86:323-337
   Web of Science | Medline

5. 5

   Barlow JB, Pocock WA. Billowing, floppy, prolapsed or flail mitral valves? Am J Cardiol 1985;55:501-502
   CrossRef | Web of Science | Medline

6. 6

   Pellerin D, Brecker S, Veyrat C. Degenerative mitral valve disease with emphasis on mitral valve prolapse. Heart 2002;88:Suppl 4:iv20-iv28
   CrossRef | Medline