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Flail leaflet or leaflet flail refers to an abnormally increased leaflet mobility of the atrioventricular valves associated with valvular prolapse and a systolic excursion of the leaflet tip or edge into the atria.
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Flail leaflet can be seen in leaflets of the mitral and tricuspid valve and usually correlate with severe valvular regurgitation, although cases with mild to moderate regurgitation do exist 1-3.
Immediate causes of flail leaflets include 1-3:
- chordae tendineae rupture or elongation
- papillary muscle rupture
- congenital (rare)
Flail leaflet is best visualized in imaging modalities with high temporal resolution as echocardiography or cardiac MRI. The main imaging feature comprises a lack of atrioventricular leaflet coaptation during systole with the leaflet and its edge being pushed beyond the annular plane into the atrial space.
Management is subject to the severity or grade of valvular dysfunction which is severe in most cases of flail leaflet. Subject to the exact etiology valvular repair with cord repair/suspension or valve replacement might be required. In cases where flail leaflet is associated with only mild or moderate regurgitation, this can be treated accordingly 2,3.
- 1. El Sabbagh A, Reddy Y, Nishimura R. Mitral Valve Regurgitation in the Contemporary Era. JACC Cardiovasc Imaging. 2018;11(4):628-43. doi:10.1016/j.jcmg.2018.01.009 - Pubmed
- 2. D'Aloia A, Bonadei I, Vizzardi E et al. Different Types of Tricuspid Flail: Case Reports and Review of the Literature. Hellenic Journal of Cardiology. 2016;57(2):134-7. doi:10.1016/j.hjc.2016.03.007 - Pubmed
- 3. Kehl D, Rader F, Siegel R. Echocardiographic Features and Clinical Outcomes of Flail Mitral Leaflet Without Severe Mitral Regurgitation. J Am Soc Echocardiogr. 2017;30(12):1162-8. doi:10.1016/j.echo.2017.06.019 - Pubmed