Echocardiographic Determination of the Prevalence of Primary Myxomatous Degeneration of the Cardiac Valves

Abstract

There is a paucity of data on the prevalence of primary myxomatous degeneration (PMD) of the cardiac valves. Because the gold standard for the diagnosis is pathology, its preoperative detection rate is relatively low. The purposes of this study were to determine the capability of echocardiography to identify PMD compared with surgical pathological findings and to determine the echocardiographic features of PMD. Echocardiograms were retrospectively compared with pathologic findings in 1,080 patients undergoing surgery for moderate or severe cardiac valve regurgitation. PMD of the mitral, aortic, and tricuspid valves was retrospectively identified, with a comparison of the echocardiographic and pathologic findings, to estimate the prevalence of PMD and to summarize its echocardiographic features. Of 1,080 patients, 104 were diagnosed with PMD (prevalence, 9.62%). Echocardiography identified valvular prolapse and thickening in 85% of patients. The echocardiographic characteristics of PMD included valvular regurgitation, valvular thickening, valvular prolapse, and rupture of chordae tendineae. Combinations of these characteristics were seen on multiple valves. Among patients with PMD, 59 had only mitral valve involvement, 25 had only aortic valve involvement, two had only tricuspid valve involvement, 10 had both mitral and aortic valve involvement, and three had both mitral and tricuspid valve involvement. In patients undergoing surgery for valvular regurgitation, a high prevalence of PMD was found. PMD has distinctive echocardiographic features, suggesting its preoperative diagnosis.