🔍 What exactly is prolapse volume? Prolapse volume is the "hidden" volume trapped between the prolapsing mitral leaflets and the annulus at end-systole. This volume: ➡️ Is not forward stroke volume ➡️ Is not transvalvular MR ➡️ Returns to the LV during diastole 🫀 Total LV volume load = MR volume + prolapse volume 💎 A paradigm-shifting concept introduced by @HeartToProve @DipanJShah @WilliamZoghbi and colleagues that may help explain disproportionate LV enlargement and remodeling in Barlow MVP. #ASEchoJC #EchoFirst #MVP @ASE360 #CardioX #MVP @JournalASEcho

💎 Why does the LV sometimes appear "too enlarged" for the degree of MR in MVP? 🫀 Because MR is not the entire volume load. In the landmark work by @HeartToProve and colleagues, adding prolapse volume to MR volume strengthened the relationship between volume load and LV enlargement. 🎯 Total volume load = MR volume + prolapse volume A powerful concept that may explain disproportionate LV remodeling in Barlow MVP. #ASEchoJC #EchoFirst #MVP @ASE360 @JournalASEcho #CardioX

Such an elegant observation, @HeartToProve 👏 💎 The bifid-E wave may be a novel Doppler marker of advanced MVP. Associated with: ➡️ Bileaflet MVP (33% vs 6% in single leaflet prolapse) ➡️ Larger prolapse volume ➡️ Disproportionate LV enlargement despite mild MR ➡️ LV replacement fibrosis 🔑 On multivariable analysis, the bifid-E wave was the only echocardiographic parameter independently associated with MVP-related fibrosis. 🔍 Sometimes the most important clues are hiding in plain sight on the mitral inflow Doppler. #ASEchoJC #EchoFirst @ASE360 @JournalASEcho #MVP #CardioX

Such an important point, @HeartToProve 💎 As highlighted in your editorial 👇, not all flails are created equal. 🎯 A flail leaflet should raise suspicion for severe MR—but it is not synonymous with severe MR. An integrated assessment remains essential. #ASEchoJC #EchoFirst @ASE360 @JournalASEcho #MVP #WhyCMR

✨ Huge thank you to everyone who joined tonight's #ASEchoJC! What an incredible discussion on MVP, MR, MAD, ventricular arrhythmias, and the evolving concept of arrhythmic MVP. 🫀⚡️ Grateful to our outstanding guest authors Dr. Jeffrey Silbiger @LucySafi, @priyaPanday27, and for sharing their expertise and insights, and to my wonderful co-moderators @NadeenFaza and @HeartToProve. A special thank you to our #EchoFirst enthusiasts and engaged audience for contributing to such a lively, thoughtful, and high-yield discussion. Proud to be part of this amazing global #EchoFirst community! 💙🌍 @ASE360 @JournalASEcho