Mitral commissural prolapse or flail, either isolated or combined with
more extensive degenerative valve disease imposes several challenges
both on its diagnosis and management whilst being a risk factor for
valve reoperation after mitral valve repair. Accurate identification of
the prolapsing segment is often not feasible with transthoracic 2D
echocardiography, with transesophageal 3D imaging then required for
correct diagnosis and surgical planning. Various surgical techniques
employed alone or in combination, have yielded good results in the
repair of commissural prolapse. Herein, we analyze the specific
characteristics of commissural disease focusing our attention on 2D and
3D echocardiographic findings and we briefly comment on techniques
employed for surgical correction of the disease.