Complications Of Mitral Valve Prolapse Research Articles

Mitral Valve Prolapse in Pregnancy.

Mitral valve prolapse is a benign condition. Mitral regurgitation is only complicated in patients with severe mitral valve prolapse. Women with mitral valve prolapse in the absence of other cardiovascular disorders tolerate pregnancy well and do not develop remarkable cardiac complications. Nevertheless, serious complications of mitral valve prolapse, including arrhythmia, infective endocarditis and cerebral ischemic events, can be present in pregnancy. Debates remain with regard to the use of prophylactic antibiotics and β-blockers in the pregnant women with mitral valve prolapse. The prognosis of the pregnant patients might be closely related to the pathological and (or) functional changes of the mitral valve. Non-myxomatous mitral valve prolapse poses no or little obstetric risks in terms of pregnancy, labor and neonatal complications; whereas myxomatous mitral valve prolapse is a major etiology of valvular heart disease in women of childbearing age. In the pregnant patients with mitral valve prolapse progressing into major complications, surgical interventions are considered. Medicinal treatment of such patients with β-blockers should be a concern for the fetal safety.

228 Echocardiographic Examination of the Incidence of Mitral Valve Prolapse and Interatrial Communication

Introduction: Mitral valve prolapse (MVP) is the most common anomaly of mitral valve with different incidence (using modern criteria) and different level of pathoanatomical abnormality. In most of the cases MVP is an isolated anomaly, but can be associated with other heart anomalies, most frequently with interatrial communication. Using the echocardiography several sequelae and complications of MVP can be identified, including mitral regurgitation, ruptured chordae, endocarditis or associations anomalies.Aim of presentation: Using the echocardiography examination to present mitral valve prolapse associated with different forms of interatrial communication.Methodology: Cross-sectional, Doppler and color-Doppler echocardiography examination.Results: During the period 2004 - 2009. in Echo-labor of Pediatrics Clinic in Prishtina were registered 214 children with MVP. 36 of them had one type of interatrial communications. Most often was persistent foramen ovale (22 children), hemodinamicly irrelevant. In 9 of them was registered restrictive ASD secundum type. 5 children had nonrestrictive ASD, one of them type VCS. In all children with nonrestrictive ASD closure was preformed, while in 2 of them open heart surgery was done.

Quadricuspid aortic valve in a patient with mitral valve prolapse

A 72-year-old man was admitted to Yuksek Ihtisas Hospital, Ankara, Turkey, with dyspnea. His medical history was remarkable only for hypertension. On physical examination, his blood pressure was 120/70 mmHg and his pulse rate was 86 beats/min. Cardiac auscultation revealed a grade 3/6 systolic murmur at the apex, and auscultation of the lungs revealed bilateral rales. A 12-lead electrocardiogram showed a normal sinus rhythm. Transthoracic echocardiography demonstrated anterior mitral valve leaflet prolapse with severe mitral regurgitation and a quadricuspid aortic valve with four equal-sized cusps, causing moderate aortic regurgitation, with an X-shaped commissural aspect in diastole. Transesophageal echocardiography demonstrated a quadricuspid aortic valve (Figures 1A and ​and1B)1B) with central moderate aortic regurgitation and a flail segment on the anterior mitral valve leaflet with severe mitral regurgitation. The patient underwent elective mitral valve replacement. Figure 1) A Transesophageal echocardiographic view in the aortic valve plane in diastole. The aortic valve demonstrated a characteristic X pattern with equal-sized cusps. B Transesophageal echocardiographic view in the aortic valve plane in systole. The aortic ... Mitral valve prolapse is a common valvular abnormality. Although the overall prognosis of patients with mitral valve prolapse is excellent, it may cause serious complications, including infective endocarditis, sudden cardiac death, cerebrovascular ischemic events and severe mitral regurgitation (1). The most important complication of mitral valve prolapse is severe mitral regurgitation, which may result from progressive myxomatous degeneration or chordal rupture (1). A quadricuspid aortic valve is a rare congenital malformation of the aortic valve. The main functional abnormality of a quadricuspid aortic valve is insufficiency (2). The structure of a quadricuspid aortic valve varies according to the dimension of each individual valve cusp: four equal cusps, three equal cusps with one minor cusp, or two large cusps with two small cusps (2). In the present case, we presented this rare condition again.

Biomechanical and echocardiographic characterization of flail mitral leaflet due to myxomatous disease: further evidence for early surgical intervention

Background Flail mitral leaflet (FML) is a common complication of mitral valve prolapse, often leading to severe mitral regurgitation (MR) and left ventricular dysfunction. In the absence of timely surgical correction, survival is significantly impaired. Early recognition of FML and identification of risk factors is important because early intervention increases the chances of survival. Methods We studied 123 patients undergoing mitral valve surgery for severe MR caused by myxomatous disease. Chart review, echocardiography, and tensile testing were performed. Results Thirty-eight patients had FML, and 85 patients had non-flail mitral leaflet (non-FML). Patients with FML were younger (53.7 ± 1.8 vs 59.3 ± 1.4 years, P = .02), had more severe MR (3.89 ± 0.04 vs 3.76 ± 0.04, P = .02), were less likely to be in New York Heart Association class III or IV heart failure (5% vs 20%, P = .037), and were less likely to have bileaflet mitral valve prolapse (5% vs 38%, P <.001) than non-FML patients. Valve tissue from patients with FML had less stiff chordae (23.5 ± 3.6 vs 59.1 ± 11.7 Mpa, P = .006) that tended to have a lower failure stress (3.8 ± 0.9 vs 9.6 ± 2.2 Mpa, P = .07) and had more extensible leaflets (56.4% ± 7.9% vs 42.9% ± 2.7% strain, P = .04) compared with that of non-FML patients. Conclusions The development of FML may result from intrinsic tissue abnormalities and is associated with a distinct subset of the myxomatous population. Identification of such clinical characteristics in this population and knowledge of an implicit mechanical abnormality of valve tissue may further the argument for early surgical correction.

Mitral valve prolapse

Mitral valve prolapse (MVP) is commonly encountered in women and has been estimated to occur in up to 21% of healthy young women. 1 In the Framingham study, it was noted that 7.6% of its female population had MVP confirmed by echocardiography; of those women, 17% were between the ages of 20 and 29, 7.5% between 50 and 59 years, and only 1% were in their 7th decade. 2 This variation in distribution of MVP ensures that a population of women in their childbearing years seen by the general obstetrician–gynecologist will have the highest prevalence of MVP. It is, therefore, important to understand the mechanism, causes, and possible complications of MVP.

Relation between QT dispersion and ventricular arrhythmias in uncomplicated isolated mitral valve prolapse.

Complications of mitral valve prolapse (MVP), among which serious ventricular arrhythmia and sudden death are of major importance, affect many individuals due to the high incidence of MVP itself in the community despite the actual low incidence of these complications. The present study investigated the incidence and distribution of ventricular arrhythmias according to their severity and relationship with the QT interval and dispersion of repolarization in uncomplicated isolated MVP (IMVP) cases. Fifty-eight uncomplicated IMVP patients, 33 patients with accompanying tricuspid valve prolapse (TVP), to compare its relationship with ventricular arrhythmia, and 60 age- and sex-matched control subjects were enrolled in the study. Individuals with accompanying cardiac or systemic disease, or who were on drug therapy that could potentially affect QT characteristics, were excluded. The incidence of ventricular arrhythmia was 48% in the IMVP group and 64% in the TVP group; the difference was statistically insignificant. In addition, the differences of the QT and Q peak T values were insignificant, whereas QT dispersion (QTd) and Q peak T dispersion (QpeakTd) values were significantly higher in the patient group (60+/-14, 54+/-14 ms, respectively) compared with the control group (42+/-10, 38+/-10 ms, respectively, p<0.001). Complex ventricular arrhythmias (Lown Grade > or =III) in the IMVP group had a significant relationship with QTd and QpeakTd (p<0.001), but not with QT or QpeakT. As a result of the study, it is concluded that TVP accompanying MVP does not increase the incidence of ventricular arrhythmia, that ventricular arrhythmia is related to QT dispersion rather than QT interval in IMVP, that the QT dispersion is a fairly good marker for identifying the high-risk group for serious ventricular arrhythmia and sudden death, and that QpeakT dispersion measurement is an additional indicator that could be an alternative when QT is difficult to determine in conditions such as high heart rate or the presence of U wave.

Mitral valve prolapse in persons with down syndrome

This study was designed to determine the prevalence of mitral valve prolapse and aortic insufficiency in home-reared, young persons with Down syndrome. Of the 36 individuals (ages 20–32 years) enrolled in this study, 20 had abnormal echocardiographic findings. Thirteen patients had mitral valve prolapse, 3 had both mitral valve prolapse and aortic insufficiency, 2 had only aortic insufficiency, and 2 had other mitral valve disorders. In 14 of the 16 patients with mitral valve prolapse, a midsystolic click was heard. Theories of the pathogenesis and possible complications of mitral valve prolapse and its relationship to exercise and sport activities are discussed.

Mitral Valve Prolapse, Panic Disorder, and Chest Pain

Mitral valve prolapse is a common cardiac disorder that can readily be diagnosed by characteristic auscultatory and echocardiographic criteria. Although many diseases have been associated with mitral valve prolapse, most affected individuals have the primary form of the disorder. Mitral valve prolapse is an inherited condition commonly associated with myxomatous degeneration of the mitral valve and its support structures. Complications of mitral valve prolapse, including cardiac arrhythmias, sudden death, infective endocarditis, severe mitral regurgitation (with or without chordae tendineae rupture), and cerebral ischemic events, occur infrequently considering the wide prevalence of the disorder. Panic disorder is a specific type of anxiety disorder characterized by at least three panic attacks within a 3-week period or one panic attack followed by fear of subsequent panic attacks for at least 1 month. It too is a common condition with a prevalence and age and gender distribution similar to that of mitral valve prolapse. Panic disorder and mitral valve prolapse share many nonspecific symptoms, including chest pain or discomfort, palpitations, dyspnea, effort intolerance, and pre-syncope. Chest pain is the symptom in both conditions that most commonly brings the patient to medical attention. The clinical description of chest pain in patients with mitral valve prolapse is highly variable, possibly reflecting multiple etiologies. Chest pain in panic disorder is usually characterized as atypical angina pectoris and as such bears resemblance to the chest pain commonly described by patients with mitral valve prolapse. Multiple investigative attempts to elucidate the mechanism of chest pain in both conditions have failed to identify a unifying cause. Review of the literature leaves little doubt that mitral valve prolapse and panic disorder frequently co-occur. Given the similarities in their symptomatology, a high rate of co-occurrence is, in fact, entirely predictable. There is, however, no convincing evidence of a cause-effect relationship between the two disorders, nor has a single pathophysiologic or biochemical mechanism been identified that unites these two common conditions. Until specific biologic markers for these disorders are identified, it may be impossible to do so. The lack of a proven cause-and-effect relationship between mitral valve prolapse and panic disorder and the absence of a unifying mechanism do not diminish the clinical significance of the high rate of co-occurrence between the two conditions. Primary care physicians and cardiologists frequently encounter patients with mitral valve prolapse and nonspecific symptoms with no discernible objective cause who fail to respond to beta-blockade. Panic disorder should be considered as a possible explanation for symptoms in such patients.(ABSTRACT TRUNCATED AT 400 WORDS)

高齢者僧帽弁逸脱症における合併症の頻度

To evaluate the difference in the frequency of complication of mitral valve prolapse (MVP) according to sex in subjects aged 60 years and older, 543 patients (218 men and 325 women) who were diagnosed as having MVP by echocardiography at the Lahey Clinic Medical Center were studied. Three hundred and fourty eight patients had no complication of MVP (male vs female = 129:219). Infective endocarditis occurred in 20 patients (male vs female = 13:7). Rupture of chordae tendineae occurred spontaneously in 29 patients (male vs female = 20:9) and were associated with infective endocarditis in 8 other patients (male vs female = 6:2). Eighteen patients required mitral valve surgery for severe mitral regurgitation. The frequencies of these complications were higher in males than those in females. Cerebral ischemic events were encountered in 54 patients. There was no significant difference in the frequency between male and female. In conclusion, MVP in elderly men might be at for cardiac complication.

Mitral valve prolapse: causes, clinical manifestations, and management.

To assess the causes, methods of diagnosis, clinical spectrum, and management of mitral valve prolapse. Results of prospective study of over 800 subjects at Cornell Medical Center from 1979 to the present were used along with studies published from 1963 to 1989 identified by computerized literature searches of Index Medicus and MEDLINE, and by hand searches. Studies involving controlled design, longitudinal follow-up, or critical assessment of diagnostic methodology, and clinical studies or previous reviews that have contributed most to the understanding of mitral valve prolapse were selected. Data concerning the causes, clinical manifestations and complications, and prevalence of mitral valve prolapse, as well as the strength of association between mitral valve prolapse and diagnostic signs, were evaluated and used to develop a practical approach to evaluating and managing patients. Most instances of mitral valve prolapse are primary and inherited, with possible genetic heterogeneity. Mitral prolapse may be diagnosed by auscultation of midsystolic clicks and late-systolic murmurs that respond typically to maneuvers, or by billowing of mitral leaflets across the mitral anular plane in long-axis, two-dimensional echocardiographic views or by a late-systolic, posterior leaflet displacement of at least 2 mm in meticulously targeted M-mode recordings. Mitral valve prolapse is associated with thoracic bony abnormalities, low body weight, low blood pressure, and a modest excess of orthostatic hypotension, syncope, palpitations, and atrial arrhythmias, but not with nonspecific symptoms (atypical chest pain, dyspnea, anxiety or panic attacks). Complications of mitral valve prolapse, including about 4000 mitral valve operations, 1100 cases of endocarditis, and possibly 4000 sudden deaths per year in the United States, are concentrated disproportionately in older men, with about 5% of affected men and 1.5% of affected women ultimately requiring valve surgery. Prophylaxis for endocarditis and closeness of follow-up should be related to the occurrence of the independent risk factors for complications of mitral prolapse (presence of mitral regurgitation, male gender, and age over 45 years), whereas active management and close observation are needed for severe mitral regurgitation and advanced ventricular arrhythmias.

Neurologic aspects of mitral valve prolapse.

Mitral valve prolapse (MVP), the most frequently encountered valvular condition in the population, has been reported in an increasing variety of neurologic, muscular, and psychiatric disorders during the last twelve years. Extensive review of reports indicates this has resulted from observations of either (1) inordinate incidence of MVP in well-defined neurologic entities or (2) development of neurologic or ophthalmologic complications attributed to MVP. In the review presented, basis is found for categorizing MVP by its association with (1) well-defined, genetically determined neurologic disorders; (2) disorders characterized by structural abnormalities, many genetically determined, or inflammatory processes of connective tissues; (3) "mechanical" prolapse resulting from disproportion of mitral valve annulus and left ventricular size, which is, at times, reversible; and (4) a generally asymptomatic state that, at times, is associated with ischemic, thrombotic, embolic, and infectious disorders of the brain and eye. The paradox between the large number of persons with MVP in the general population who remain healthy and a subpopulation of patients with complications of MVP (eg, stroke) or other entities has been identified. A second paradox is found between the well-known increased incidence of MVP, especially in young patients with stroke, and the apparent rarity of stroke among patients with both common (eg, migraine) and unusual (eg, myotonic dystrophy) neurologic entities in which an extraordinary high prevalence of MVP is known to exist.

Mitral leaflet billowing and prolapse: its prevalence around the world.

Primary mitral leaflet billowing, or so-called mitral valve prolapse, has become the most common valve anomaly in the United States and is also frequently found throughout the world. Its prevalence varies from less than 1% to 38%, differing not only between countries but also within the same country. The prevalence depends on whether the study is clinical or echocardiographic, based on autopsy or surgical material, or of hospital or non-care-seeking population. Other explanations for the varying prevalence are the age, sex and weight differences of the study population, imprecise terminology, the care with which auscultation and/or echocardiography are carried out and interpreted, and some selection biases. Although prevalent throughout the world, the condition is generally benign and can often be regarded as a normal variant. Among the complications of mitral valve prolapse, progressive mitral regurgitation and infective endocarditis are particularly noteworthy. Primary mitral valve prolapse is currently a leading cause of mitral regurgitation and also of infective endocarditis.

Lifetime risk for patients with mitral valve prolapse of developing severe valve regurgitation requiring surgery.

Severe mitral regurgitation requiring surgery is the most common life-threatening complication of mitral valve prolapse (MVP) and is due to progressive myxomatous change in the valve. We identified all residents of New South Wales, Australia, who had mitral valve surgery for myxomatous valve disease during 1982 and, using these data and the adult population statistics from 1982, estimated the cumulative risk of valve surgery in patients with MVP. In 1982, 50 of the 5.36 million New South Wales residents required surgery for this complication of MVP. Of the 50, 36 were men and 14 were women, which was significantly different from the population sex distribution (p less than 0.02) for mean age +/- SD of 60 +/- 11 years (range, 26-78 years). Using our previously determined 4% prevalence of adult MVP in New South Wales, we estimated the number of male and female patients with MVP at risk for each 5-year age interval and calculated age-specific event rates. The results show that the cumulative risk is minimal below the age of 50 years but then rises steeply, particularly in men. The risks in men aged 50, 60, and 70 years (with 95% confidence intervals) were 1:202 (130-448), 1:53 (37-82), and 1:28 (22-41), respectively. In women, the risk was less than half that in men (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Mitral valve prolapse and the anxiety disorders.

Confusing and contradictory results have emerged from studies of the relationship between anxiety disorders and mitral valve prolapse (MVP), a commonly occurring heart defect that has been associated with chest pain, palpitations, tachycardia, and arrhythmias. Patients with anxiety disorders, particularly panic attacks, appear to have an increased prevalence of MVP compared with control groups or the general population, although most individuals with MVP are asymptomatic. MVP does not appear to distinguish a subgroup of patients with panic disorder on the basis of vulnerability to panic attacks, symptom presentation, biological abnormalities, or treatment response. The authors review some current hypotheses about causal relationships between anxiety disorders and MVP, describe methods of diagnosing MVP and their shortcomings, and identify possible medical complications of MVP and ways to treat or prevent them.

Frequency of complications of mitral valve prolapse in subjects aged 60 years and older

One hundred forty-five patients (74 women, 71 men), aged 60 years and older, with echocardiographically documented mitral valve prolapse were studied. One hundred sixteen patients had precordial systolic murmurs, 20 of whom were suspected of having mitral valve prolapse before the echocardiographic study. Infective endocarditis occurred in 7 patients, cerebral ischemic events in 13 and spontaneous rupture of chordae tendineae in 33. Four other patients had ruptured chordae tendineae associated with infective endocarditis. Congestive heart failure was present in 35 patients, 11 of whom had undergone mitral valve surgery.

Complications of mitral valve prolapse: Disproportionate occurrence in men and older patients

To determine factors influencing the strength of association between mitral valve prolapse and mitral regurgitation, ruptured chordae tendineae, and infective endocarditis, the prevalence of mitral prolapse in patients with disease was compared with both clinical and population control groups. The prevalence of mitral valve prolapse was 4 percent among population and clinical control groups (eight of 196 and 84 of 2,146, respectively) and was significantly higher (p <0.001) in patients with endocarditis (11 of 67, 16 percent), mitral regurgitation (17 of 31, 55 percent, and ruptured chordae (27 of 43, 63 percent). Odds ratios for complications in persons with mitral valve prolapse ranged from 4.6 for endocarditis to 41.4 for ruptured chordae in overall analyses, and from 6.8 for endocarditis to 53.0 for ruptured chordae based on age- and sex-matched case-control triplets (p <0.001 for each). All complications occurred disproportionately in men with mitral valve prolapse, in whom odds ratios ranged from 2.5 to 7.4 compared with an additional control group of unselected subjects with mitral valve prolapse. Compared with this control group, patients with mitral valve prolapse and endocarditis were slightly more likely to have a previously known heart murmur (odds ratio 3.2, difference not significant) but significantly more likely to have murmurs at the time of evaluation (odds ratio 8.5, p <0.01). Patients with mitral valve prolapse and mitral regurgitation and ruptured chordae tendineae were also significantly older than the unselected subjects with mitral valve prolapse (48 ± 14 and 55 ± 16 versus 38 ± 14 years, p <0.005 for both). The concentration of risk of endocarditis in men with mitral valve prolapse and patients with antecedent murmur suggests that antibiotic prophylaxis is warranted in these groups but not in women without a murmur of mitral regurgitation.

Age and the clinical profile of idiopathic mitral valve prolapse.

The prevalence of mitral valve prolapse was determined in two independent populations (6887 consecutive adults and children referred for echocardiography during a three year period and 206 non-referred first degree relatives of 65 patients with mitral valve prolapse). In the 118 adults with echocardiographic evidence of prolapse those aged greater than or equal to 50 years were significantly more likely to have pansystolic murmurs and increased echocardiographic dimensions than those aged less than 50 years; and patients with complications of mitral valve prolapse were significantly older than those without. In the population referred for echocardiography and in the non-referred relatives there was a significant increase in prevalence in the two decades after adolescence (20-39 years) compared with that in the first two decades. The data suggest that prolapse principally becomes manifest in late adolescence when the growth spurt is complete and that thereafter the severity of prolapse increases with age in an important subset of patients. The latter findings accord with the predictions of the response to injury hypothesis for the pathogenesis of progressive changes.

Neurologic disorders associated with mitral valve prolapse.

Mitral valve prolapse has been reported to be associated with a variety of neurologic disorders, including cerebral ischemia, transient global amnesia, migraine, autonomic dysfunction, and psychiatric disease. The evidence supporting these associations and possible pathogenetic mechanisms are discussed. Some neurologic disorders may be direct complications of mitral valve prolapse, while others may occur as part of an underlying genetic defect or common link.

Sudden death in primary mitral valve prolapse

Sudden unexpected death is a recognized complication of mitral valve prolapse (MVP), but well-documented cases are rare and either clinical details or necropsy findings are absent or scanty. One of our patients, a young woman with MVP who had been fully investigated’e2 and followed since childhood, died suddenly at the age of 24 years, and we were able to obtain detailed pathologic findings. At the age of 8 years a grade 216 late systolic murmur and a nonejection click were heard (see Fig. 10 of Ref. 1). Occasional ectopic beats were present, but she was asymptomatic. Chest x-ray examination was normal. The ECG (see Fig. 11 of Ref. 1) showed slight ST segment elevation with T wave inversion in leads 2, 3, and AVF. Left ventricular cineangiography (see Fig. 12 of Ref. 1) demonstrated mild mitral regurgitation and marked prolapse of the posterior leaflet. Her father had an isolated nonejection click. A diagnosis of MVP on a familial basis was made, and no treatment was given. She attended the clinic at B-month intervals and remained asymptomatic. At 13 years of age numerous multifocal ventricular premature contractions were recorded after a strenuous exercise test (See Fig. 2, a of Ref. 2). On propranolol, 80 mg daily, and diphenylhydantoin, 300 mg daily, the arrhythmia was suppressed. She was thereafter assessed at yearly intervals

Focal Cerebral Ischemia and Mitral Valve Prolapse in Monozygotic Twins

Mitral valve prolapse (MVP) is a common frequently inherited cardiac valvular disorder. Ischemic cerebrovascular disease (ICVD) is an apparent complication of MVP. We report the concordance of MVP and ICVD in a pair of monozygotic twins. This occurrence reinforces the concepts that MVP is highly concordant in monozygotic twins and that it can be the cause of familial ICVD.