DK2985_C000 1..28 - AlSharqia Echo Club

396 Transesophageal Echocardiography(A)(B)P2LAP1P3LV(C)(D)P2LALVRV(E)(F)P2P2Figure 17.17 75-year-old man with a prolapsed P2 scallop secondary to chordal rupture. (A–D) Mid-esophageal views at 908 withclockwise rotation. (E, F) Corresponding intraoperative findings with the excised P2 scallop (LA, left atrium; LV, left ventricle; RV, rightventricle). (Photos E and F courtesy of Dr. Michel Pellerin.)mitral annulus. Leaflet motion should be described asbeing excessive, normal, or restricted if a portion of theleaflet moves during closure respectively beyond, at orunder the annulus plane, using the classification ofCarpentier (Table 17.2).Excessive leaflet mobility is a frequent mechanismand the ensuing jet is typically directed toward the contralateralside of the pathologic leaflet. Myxomatousdegenerescence and endocarditis are the usual culpritdiseases. Regurgitation caused by papillary muscle infarctionusually originates from its respective commissuralarea.In contrast, restricted leaflet motion results in a jetdirected towards the side ipsilateral to the affectedleaflet. If both leaflets are equally limited, the jet isusually central. The most frequent cause of restrictedleaflet motion is ischemia. Rheumatic valve disease canalso cause restriction in leaflet motion (29).