Aqui link . Evidence of a Vicious Cycle in Mitral Regurgitation With Prolapse: Secondary Tethering Attributed to Primary Prolapse Demonstrated by Three-Dimensional Echocardiography Exacerbates Regurgitation .
. Background—: In patients with mitral valve prolapse, nonprolapsed leaflets are often apically tented. We hypothesized that secondary left ventricular dilatation attributed to primary mitral regurgitation (MR) causes papillary muscle (PM) displacement, resulting in this leaflet tenting/tethering, and that secondary tethering further exacerbates malcoaptation and contributes to MR severity. . Conclusions—: These results suggest that primary mitral valve prolapse with MR causes secondary mitral leaflet tethering with PM displacement by left ventricular dilatation, which further exacerbates valve leakage, constituting a vicious cycle that would suggest a pathophysiologic rationale for early surgical repair. .
. A análise do Prolapso Mitral ao 3D é muito mais rica que ao 2D . e permite a conclusão acima: Quanto mais PVM, mais refluxo que provoca mais PVM! .