Mitral valve




The mitral valve consists of two leaflets, the anterior (A) and the posterior valve leaflet (P), which together have a surface area of 4-6cm². At the inner edges of the leaflets chordae tendinae are attached, which ensure that the leaflets did not prolapse back into the atria during systole. The chordae attach to two large papillary muscles, that are part of the muscular tissue of the left ventricle.

The mitral valve can be visualized in many views: PLAX, PSAXmv, AP4Ch, AP5Ch, AP2Ch, AP3Ch and subcostaal4Ch. A prolapse of the MV is best assessed on PLAX. However, mitral regurgitation should be assessed in all views. In case of major abnormalities of the mitral valve 3D TOE has additional value in assessing the anatomy and function.


Ruptured mitral chordae tendineae assessed with 3D TOE


MV scallop partition




Quantification of mitral valve regurgitation
Parameter Gering Matig Ernstig
Jetoppervlak/LA (%) <20 20-40 >40
Jetoppervlak (cm²) <4 4-10 >10
ERO (mm²) <20 20-40 >40
Vena contracta (mm) <3 3-7 >7


Severe MR because of prolaps


Causes of mitral valve regurgitation
Annulus dilatatie Degeneratie Verworven klepafwijking Secundair
Atriumfibrillatie Malcoaptatie bij mitralisklepsteonose Billowing Ritmestoornissen (LBTB-->diastolische MI)
Linkerventrikel dilatatie Prolaps SAM bij HCM
Linkeratrium dilatatie Floppy valve




Quantification of mitral stenosis
Parameter Gering Matig Ernstig
MVA (cm²) >1.5 1.5-1.0 <1.0
PGmean (mmHg) <5 5-10 >10
PHT (m/s) <90 90-150 >150


Causes of mitral stenosis
Acquired Tumor Congenital
Degeneracy Myxoma Parachute valve
Rheumatic fever Cor triatriatum sinistrum


Severe MS because of degeneration


Pane D

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