Abstract 19066: God Fixed It! A Case of Mitral Valve Prolapse

Abstract

Background Mitral Valve prolapse (MVP) occurs in 1.2 to 3% of the population. Myxomatous degeneration is the most common cause of MVP in the United States. Clinical features range from asymptomatic to serious complications such as heart failure, endocarditis, arrhythmias, and sudden cardiac death. Patients with MVP may develop severe mitral regurgitation (MR) requiring surgery. We present a unique case of severe MR in a patient with MVP. Case A 67-year-old male with a history of Dysautonomia and Parkinson’s disease presented to the cardiology clinic with complaints of exertional dyspnea, lightheadedness, and palpitation. Transthoracic echo was obtained as part of the workup revealing ejection fraction>55%, Myxomatous Mitral Valve with significant prolapse of the posterior leaflet which was partially flail causing severe MR, regurgitant volume of 149 cc, and percentage of 69%. Cardiac catheterization showed normal coronaries. A transesophageal echo to evaluate the MR and surgical repair of the mitral valve was offered, but the patient refused surgery. He was later lost to follow-up. After 4 years, he presented to the clinic with some exertional dyspnea. Repeat echo revealed moderately calcified posterior leaflet with less mobility causing only moderate MR. His MR continued to improve, an echo after 5 years revealed increasing calcific changes involving posterior leaflet and chordal attachment, causing mild MR and mitral stenosis. Discussion Isolated MVP can develop degenerative MR in up to 25%, and 0.4 to 1.9% can suffer sudden cardiac death. Surgery is recommended for severe symptomatic MVP with MR and it is considered fatal if left unrepaired. In this case, the patient refused surgery and had an unusual natural history of valve calcification leading to decreased mobility, reduced prolapse, and converting severe MR into mild. To our knowledge, this is the first case in literature where there is a self-correction of MVP due to the calcification of the valve leaflet.