Transformation of mitral valve prolapse to dynamic left ventricular outflow tract obstruction and back again in a patient with acute transient myocardial depression

We describe an unusual case of transient resolution of preexisting mitral v alve (MV) prolapse during acute cardiac dysfunction and the development of dynamic left ventricular (LV) outflow tract obstruction. The patient presen ted with lightheadedness, chest pain, and compromised hemodynamic status. E chocardiography revealed akinesis and deformation of the LV anterior wall a nd apex, hyperdynamic activity in the bases, anterior MV leaflet systolic a nterior motion without prolapse, and a dynamic outflow tract gradient. Myoc ardial function fully recovered over 1 month. Repeat ultrasonography showed posterior MV leaflet prolapse and no anterior MV leaflet systolic anterior motion. Elongated MV leaflets may have contributed to dynamic outflow trac t obstruction and life-threatening hemodynamic compromise during LV conform ational change.