Cases Of Mitral Valve Prolapse Research Articles

Comparative Evaluation of Mitral Valve Strain by Deformation Tracking in 3D-Echocardiography

We present new algorithms to compute patient specific strain maps for mitral valve leaflets, by tracking and modeling deformations of the mitral valve apparatus in 3D echocardiography. We can then quantify comparisons of mitral leaflets strain maps between normal patients and cases of mitral valve prolapse or regurgitation. For patients with mitral valve regurgitation, we compare mitral leaflets strain maps between pre-surgery and post-surgery, to quantify the strain reduction due to mitral valve repair surgery.

A case of mitral valve prolapse complicated by chordal rupture due to rapid progression of aortic stenosis

A case of mitral valve prolapse complicated by chordal rupture due to rapid progression of aortic stenosis

Anterior Mitral Valve Length is Associated with Ventricular Tachycardia in Patients with Classical Mitral Valve Prolapse

The aim of this study was to investigate the electrocardiographic and echocardiographic predictors of ventricular tachycardia (VT) in patients with classical mitral valve prolapse (MVP). Thirty patients (nine men and 21 women; mean age, 41.5 ± 15 years) in sinus rhythm with mitral valve prolapse who had VT in 24-hour Holter analysis and 30 patients with MVP without VT (eight men and 22 women; mean age, 43 ± 16 years) were included in this study. Transthoracic echocardiography, QT analyses from 12-lead electrocardiography, and 24-hour Holter electrocardiogram recordings were performed. Mitral posterior leaflet thickness (0.48 ± 0.03 cm vs 0.43 ± 0,08 cm, P = 0.025), mitral anterior leaflet length (3.2 ± 0.24 cm vs 2.9 ± 0.36, P < 0.001), mitral posterior leaflet length (2.2 ± 0.3 cm vs 1.9 ± 0.35 cm, P = 0.01), left atrium anteroposterior diameter (4.2 ± 0.8 cm vs 3.5 ± 0.5 cm, P = 0.001), and mitral annulus circumference (15.7 ± 1.3 cm vs 14.6 ± 1.6 cm, P = 0.004) were increased significantly in MVP cases with VT. No significant difference was found between the cases with and without VT in terms of frequency- and time-domain analysis. QT dispersion (72 ± 18 ms vs 55 ± 15 ms, P = 0.0002) and corrected QT dispersion (QTcD) (76 ± 18 ms vs 55 ± 15 ms, P = 0.0002) were significantly increased in cases with VT compared with those without VT. Based on logistic regression analysis for MVP cases, in the case of VT, an enhancement in QTcD (P = 0.01) and the mitral anterior leaflet length (P = 0.003) were the independent predictors of VT. Mitral anterior leaflet length and enhanced QTcD are closely related with VT in patients with classical MVP.

Congenital Double-Orifice Mitral Valve with Mitral Valve Prolapse and Severe Mitral Regurgitation

Introduction Double-orifice mitral valve (DOMV) is a rare congenital malformation. This anomaly is usually detected at an early age because it is frequently associated with other cardiac malformations. However, there also have been a few reports of isolated DOMV. In these patients, the mitral valve function is usually normal, and most of the patients are asymptomatic at the time of diagnosis. We experienced a case of mitral valve prolapse and severe regurgitation of congenital DOMV.

Review of Pathologic Findings in Remnant Hearts Following Valve Donation

The failure of medical examiners/coroners (ME/C) to allow heart valve donation is a major problem encountered by tissue agencies. Even though many ME/C favor tissue donation they remain responsible for determination of cause and manner of death. In 2001, the Jesse E. Edwards Registry of Cardiovascular Disease was approached by one of the nation's largest tissue procurement agencies (The American Red Cross--ARC) for the purpose of performing cardiovascular pathologic examinations following valve donation. The affiliation existed from October 2001 to January 2005. This study was undertaken to review all 593 postvalve recovery heart remnants received during that time period to tabulate the abnormalities identified and to determine whether donation interfered with the determination of cause of death. For each case, a preliminary cause of death was provided by the ARC. The decedent's body height and weight were also provided. Using the preliminary cause of death, the 593 cases were divided into natural and nonnatural manner of death groups. This division of the cases resulted in 106 cases placed in the natural manner of death group and 487 cases in the nonnatural manner of death group. For each case, all cardiac findings including significant conditions, additional findings, incidental findings, and congenital abnormalities were tabulated. Within the natural manner of death group, 15 cases had a noncardiac cause of death and 91 cases had a cause of death suspected to be cardiac related. In the 91 cases, a total of 132 significant cardiac findings were identified and there were six structurally normal hearts including two infants. In the nonnatural manner of death group, 214 significant cardiac findings were identified and 222 cases had a structurally normal heart. In both natural and nonnatural groups, the most common cardiac abnormality was atherosclerotic coronary artery disease. Other frequently encountered conditions were also identified including 11 cases with acute angle of origin of a coronary artery (five cases natural group; six cases nonnatural group). An important feature of this review was the recognition of potentially inheritable conditions that were diagnosed in both natural and nonnatural manner of death groups. There were three cases of hypertrophic cardiomyopathy (one natural; two nonnatural), three cases of arrhythmogenic right ventricular cardiomyopathy (one natural; two nonnatural), and one case of mitral valve prolapse (natural). In reviewing these cases, we did not feel that valve donation severely impaired cardiac pathologic examination. The benefits of cardiovascular pathologic examination by a cardiac pathologist include the identification of significant and incidental findings and recognition of potentially inheritable conditions.

Association between urokinase-plasminogen activator gene T4065C polymorphism and risk of mitral valve prolapse

Background: Abnormalities of collagen and elastic fibers were found in floppy mitral valves (FMV). Urokinase-plasminogen activator (PLAU) was suggested to be involved in the pathogenesis of elastin and collagen degradation in arterial aneurysm. The role of PLAU genetic variant in mitral valve prolapse (MVP) has not been studied. We, therefore, performed a case-controlled study investigating the possible relation between the PLAU gene polymorphisms and risk of MVP in Taiwan Chinese. Methods: We studied 100 patients with MVP diagnosed by echocardiography and 106 age- and sex-matched normal control subjects. The T4065C and T3995C polymorphisms of the PLAU gene were identified by polymerase chain reaction (PCR)-based restriction analysis. Results: There was a significant difference in either the genotype distribution or allelic frequencies between MVP cases and controls for PLAU gene T4065C polymorphism ( P=0.0001 and 0.0002, respectively). An odds ratio for risk of MVP associated with PLAU T4065C TC genotype was 6.03 (95% confidence interval 2.11–14.83). An odds ratio for risk of MVP associated with PLAU T4065C T allele was 4.99 (95% confidence interval 1.93–12.91). There was no significant difference in either the genotype distribution or allelic frequencies between MVP cases and controls for PLAU T3995C polymorphism. Further categorization of the MVP patients into mild and severe subgroups revealed no statistical difference between these two subgroups for PLAU T4065C and T3995C polymorphisms. Conclusions: This study shows that patients with MVP have a higher frequency of PLAU T4065C TC genotype and T allele that supports a role of the PLAU T4065C polymorphism in determining the risk of MVP among the Chinese population in Taiwan.

Lack of association between perlecan gene intron 6 BamHI polymorphism and risk of mitral valve prolapse in Taiwan Chinese.

Abnormalities of proteoglycan, collagen, and elastic fibers were found in floppy mitral valves. Perlecan is one of the three major classes of heparan sulfate proteoglycans within the cardiovascular system. The role of perlecan genetic variant in mitral valve prolapse (MVP) has not been studied. We therefore performed a case-controlled study investigating the possible relation between the perlecan gene intron 6 BamHI polymorphism and MVP among the Chinese population in Taiwan. We studied 100 patients with MVP diagnosed by echocardiography and 100 age- and sex-matched normal control subjects. The perlecan gene intron 6 BamHI polymorphism was identified by polymerase chain reaction-based restriction analysis. There were no significant differences in either the genotype distribution or allelic frequencies between MVP cases and controls for perlecan gene intron 6 BamHI polymorphism (P = 0.20 and 0.76, respectively). Further categorization of the MVP patients into mild and severe subgroups also revealed no statistical difference from controls for perlecan gene intron 6 BamHI polymorphism. It is concluded that perlecan gene intron 6 BamHI polymorphism is not a suitable genetic marker of MVP in Taiwan Chinese.

942-41 Dysplasia of the Atrioventricular Nodal Artery in Patients with Mitral Valve Prolapse and Sudden Cardiac Death

Patients with isolated mitral valve prolapse (MVP) without significant mitral regurgitation are at a slightly increased risk of sudden cardiac death compared to the normal population. The mechanism(s) of sudden cardiac death in isolated MVP are uncertain. We studied gross hearts and histologic sections of the atrioventricular (AV) node in 21 patients with isolated MVP dying suddenly without apparent cause other than MVP (Group 1, mean age 36 ± 8 years, mean heart weight 420 ± 89 grams). No patient in Group 1 had a history of or treatment for mitral regurgitation, and no left atrial dilatation was present at autopsy. Sudden cardiac death MVP cases were compared to 15 control hearts from trauma victims without cardiac disease (Group 2, mean age 30 ± 7 years, mean heart weight 350 ± 96 grams). Sections of the artery to the AV node within the atrial septum (mean 7 levels in each group) were stained for elastic tissue and proteoglycans. Dysplasia was defined as focal deposition of proteoglycans within the media and partial disruption of the internal elastic lamina. The ratio of lumen area to arterial area was determined by computerized planimetry at the level of greatest luminal narrowing and measured (mean ± SEM) 0.33 ± 0.04 for Group 1 and 0.52 ± 0.04 for Group 2 (p = 0.001) this ratio was independent of heart weight, age, or sex of patient by stepwise regression. Dysplasia of the AV nodal artery was present in 9/21 (43%) hearts in Group 1 versus 1/15 (7%) hearts in group 2 (p &lt; 0.02) We conclude that narrowing of the AV nodal artery and arterial dysplasia are more prevalent in patients with MVP and sudden cardiac death than controls and may represent a more generalized disorder of proteoglycan deposition. The relationship between these findings and sudden cardiac death needs to be further studied.

Histopathologic evidence for cardiomyopathy in a child with mitral valve prolapse

An intriguing relationship between idiopathic mitral valve prolapse (MVP) and cardiomyopathy has been reported in adult cases of MVP. This paper reports a girl with idiopathic MVP, who presented with progressive cardiomegaly and cardiomyopathic findings or, cardiac biopsy; right ventricular endomyocardial biopsy at the age of 15 years showed myocardial hypertrophy, disarray, myocardial degeneration, interstitial fibrosis and endocardial thickening. To our knowledge, this is the first case of idiopathic MVP in childhood that has been shown to have positive biopsy findings for cardiomyopathy.

Secundum atrial septal defect repair: long-term surgical outcome and the problem of late mitral regurgitation.

This study examines the clinical and surgical outcome of a group of 55 patients (mean age 33 years) with secundum atrial septal defect who underwent surgical repair of this defect between 1981 and 1990. A group of 25 of these patients underwent late echocardiographic follow-up. Fifty-two patients underwent repair by direct suturing and three by patch closure. Surgical mortality was nil. There was one late death of a 58 year old who died from cardiac failure 4 years after surgery. Late postoperative morbidity consisted of two patients; one, age 63 at the time of surgery, required mitral and tricuspid valve replacement 6 years later and one, age 77 at surgery, developed cardiac failure 3 years later. Atrial fibrillation persisted in the six patients who had the rhythm before surgery and developed postoperatively in two patients aged 54 and 58. Two patients aged 49 and 57 developed immediate postoperative sinus node dysfunction requiring permanent pacing. The mean age at surgery of those six patients who suffered cardiac morbidity was 60 years. The patients with preoperative angiographic evidence of mitral valve prolapse were significantly older (P < 0.001) and had higher mean pulmonary artery pressures (P < 0.001) than patients with normal valves. There was no significant relationship between shunt size and mitral valve prolapse. Echocardiographic follow-up showed persistent mitral valve prolapse in all nine patients who developed the condition preoperatively. Five patients developed mitral valve prolapse with mitral regurgitation postoperatively, one of whom needed subsequent mitral and tricuspid valve replacement. These five patient were on average older (mean age 54) but the group was too small to prove significance. The follow-up data illustrate the current low mortality and morbidity associated with surgical closure of atrial septal defects. Late postoperative echocardiography had revealed not only that mitral valve prolapse persists in those patients who developed the condition pre-operatively but that new cases of mitral valve prolapse with mitral regurgitation can occur after atrial septal defect closure.

Mitral valve prolapse in a patient with epidermolysis bullosa

SummaryMitral valve prolapse has been assoicated with several connective tissue and developmental disorders, including Ehlers‐Danlos syndrome, Marfan's disease; pseudo‐xanthoma elasticum, myotonic dystrophy. cardiomyopathy, Ebstein's anomaly of the tricuspic valve and atrial septal defect of the ostium secundum variety. Presented here is a case of mitral valve prolapse in a patient with epidermolysis bullosa. The author is unaware of any previously reported cases of this association.

Thromboembolism in patients with advanced mitral valve prolapse

Thromboembolism in mitral valve prolapse (MVP) has been suggested to occur in relation to valvular cul-de-sac recesses and endothelial wear-and-tear denudations. Such pathology would be suspected to be prominent in advanced cases of MVP necessitating open-heart operation. We therefore analysed the prevalence of perivalvular thrombi and episodes of systemic arterial embolism (SE) prior to operation in 21 consecutive patients with MVP and severe valve regurgitation. No perivalvular or left atrial thrombi were found during open-heart surgery, but three of the patients (14%, 3-36% with 95% confidence limits) experienced SE, in one case despite long-term anticoagulation. All cases of SE took place less than 3 months before operation. The results indicate that persistent thrombi are rare in MVP and severe valve regurgitation. However, such patients run a substantial risk of SE when they reach a clinical and haemodynamic stage that makes valve surgery mandatory.

Mitral valve prolapse as a risk factor for TIA. A study with echocardiography and dynamic ECG.

The present study has been devoted to the analysis of 120 patients presenting with reversible focal cerebral ischemia without conventional signs of cardiopathy and/or relevant atherosclerotic disease. In 77% of the patients vascular risk factors, such as hypertension or hyperlipemia, were present. In 23% of the patients, no abnormal finding was discovered at clinical, hematochemical and cardiological examinations. In these patients a further cardiological evaluation was performed with echocardiography. Dynamic electrocardiography was performed in 52 patients. Echocardiography and dynamic electrocardiography revealed the occurrence of 6 cases of mitral valve prolapse (MVP), 2 cases of frequent premature ventricular beats, and 1 proximal atrial arrhythmia. All 6 cases of MVP were detected in the subgroups of patients without vascular risk factors. In our patients younger than 45 years, the relative frequency of MVP attains 21.5%. This study confirms that MVP has to be regarded as a risk factor for focal cerebral ischemia in young patients.

Idiopathic mitral valve prolapse-analysis by real-time two-dimensional echocardiography.

Mitral valve prolapse is diagnosed in real-time two-dimensional echocardiograms when there are discrepancies in the coaptation zone of the anterior mitral leaflet and the posterior mitral leaflet. Out of the 100 cases of mitral valve prolapse diagnosed in this way, 65 had prolapsed anterior mitral leaflets, 28 prolapsed posterior mitral leaflets and 7 prolapses of both the anterior and posterior mitral leaflets. In addition to the cases with mitral valve prolapse 23 cases of ruptured chordae tendineae of the mitral valve, including 15 cases which had undergone surgery, were investigated. The frequent site of mitral valve prolapse was the posteromedial commissure in the anterior leaflet and the posteromedial and anterolateral commissures in the posterior leaflet. These sites coincide with those where rupture of the chordae tendineae of the mitral valve was apt to occur. An investigation of the relation between age and mitral valve prolapse showed that the number of cases of prolapsed anterior leaflet did not increase with age, but there was an age-related increase in the number of cases of prolapsed posterior leaflets. It was also found that the degree of the prolapse progressed with age. Many of the cases of ruptured chordae tendineae of the mitral valve were in their forties or fifties, and there appeared to be some relation between the progress of the prolapse and age. Mitral regurgitant murmurs were recorded on phonocardiograms, and the severer the degree, the wider the range of the prolapse. Mitral regurgitation was more likely to occur in cases of prolapsed posterior leaflets than in those with prolapsed anterior leaflets, even if the degree and the range of the prolapse were mild.

Mitral valve prolapse and infective endocarditis : Corrigall D, Bolen J, Hancock EW, Popp RL: Am J Med 63: 215–222, 1977

Mitral valve prolapse (MVP) has been described as the most common diagnosed valvular cardiac abnormality with prevalence estimates varying from 5-15% of patients in general population with predominate in female. It's relation to age and body habitus has been well studied. Severe mitral regurgitation (MR) caused by MVP is more common in man and old aged patients. Many studies have also suggested that MVP is associated with progressive mitral regurgitation, bacterial endocarditis, cerebral emboli, and sudden death. We collected 96 cases of MVP from December 1981 to May 1988 at Far Eastern Memorial Hospital (FEMH). Included 51 males, and 45 females, with a mean age of 31.4 years (range 11 to 62). Nine cases were confirmed to have MVP and MR (pansystolic murmur) by echocardiogram and phonocardiogram. Four of them had clinical manifestation of infective endocarditis (IE) with 3 case's Quetelet's index less than 20 kg/M^2. We found that there is a good relation between MVP with MR, low body weight and infective endocarditis. Age factor is independent to IE in these cases.