Malapposition of the mitral valve: a two-dimensional echocardiographic sign of left ventricular dysfunction.

A pattern of mitral valve closure (malapposition) was observed in 75 of 1,267 patients examined with two-dimensional echocardiography. Criteria defining malapposition are: (a) the mitral valve leaflets exhibit a reduced area of coaptation during systole, (b) the angle at the point of coaptation of the anterior and posterior mitral valve leaflets becomes progressively more obtuse, approaching 180 degrees, and (c) the atrioventricular groove, the coaptation point, and the basal portion of the aortic root lie along the same vertical line. Malapposition appears to be the common denominator of previously described M-mode abnormalities seen in altered left ventricular hemodynamics and dysfunction.