Evidence Of Mitral Valve Prolapse Research Articles

Mitral valve prolapse after long-term mechanical ventricular unloading

Three men with non-ischemic cardiomyopathy and heart failure (HF) underwent HeartMate II (Thoratec, Pleasanton, CA) left ventricular assist device (LVAD) placement as a bridge to heart transplantation. At baseline, all patients had severe LV dilatation, LV systolic dysfunction, and mitral annular dilatation, but no historical or echocardiographic evidence of mitral valve prolapse (MVP; Table 1). Mechanical unloading and reverse LV remodeling was achieved within 6 to 9 months of LVAD support in all patients, as evidenced by reductions in LV short-axis and long-axis dimensions, decreases in mitral annular diameter, and increases in LV ejection fraction (Table 1).

Patienten mit transitorischer ischämischer Attacke: Ihr kardialer Status und seine prognostische Bedeutung

In 51 consecutive patients with acute transitory cerebral ischaemia cross-sectional echocardiograms, 24-hour electrocardiograms (ECG) and exercise ECGs were recorded. The subsequent observation period averaged 13 (3-30) months. The echocardiogram was abnormal in 27 of 46 patients (58%). A holosystolic mitral-valve prolapse was found in eight: cerebral ischaemia recurred in five. There was no correlation between arrhythmias in the 24-hour ECG and renewed cerebral ischaemia. In addition to the 14 patients who--according to history and resting ECG--had already had a myocardial infarction, the exercise ECG revealed probably coronary heart disease in a further 11, i.e. half of the patients had coronary heart disease. Renewed attacks of cerebral ischaemia occurred in 13 patients during the follow-up period; four patients died, all of them also having had coronary heart disease. Because of the high prevalence of coronary heart disease (often previously undiagnosed) in the whole group, routine exercise ECGs are recommended for patients with transitory ischaemic attacks, protracted ischaemic neurological deficit or "minimal stroke", while 24-hour ECG monitoring does not seem essential. Randomized trials are needed to determine whether patients with cerebral ischaemia and echocardiographic evidence of mitral-valve prolapse should be treated prophylactically.

P3367 Telesystolic mitral regurgitation without evidence of mitral valve prolapse: a marker of mitral involvement in Marfan syndrome?

P3367 Telesystolic mitral regurgitation without evidence of mitral valve prolapse: a marker of mitral involvement in Marfan syndrome?

EUS in the diagnosis of aberrant subclavian artery

weight loss. The radial pulses were normal in both arms as was the blood pressure in both the right and left arms. A stress echocardiogram showed evidence of mitral valve prolapse. Barium contrast esophagogram revealed mild extrinsic compression at the level of the aortic arch, but a 13 mm diameter barium pill passed through the esophagus without difficulty. Upper endoscopy revealed no abnormality in the esophagus. Esophageal manometry obtained mean lower esophageal sphincter (LES) pressure of 16 mm/Hg. The percentage of relaxations in response to swallows exhibited by the LES was 66%. Incomplete relaxations of LES were recorded, although good peristaltic contractions were noted in the body of the esophagus (amplitude: 25–50 mm/Hg with mean amplitude of 45 mm/Hg). The percentage of simultaneous esophageal contractions was 30%. There was neither increased intraeFrom the Endoscopy Section, Beebe Medical Center, Lewes, Delaware, and Christiana Care Hospital, Christiana, Delaware. Presented in part as video poster at annual scientific meeting of American College of Gastroenterology in Phoenix, Arizona, October 18-20, 1999. Reprint requests: Vinod K. Parasher, MD, Director of Endoscopy, Beebe Medical Center Department of Medicine, 424 Savannah Road, Lewes, DE 19958. Copyright © 2001 by the American Society for Gastrointestinal Endoscopy 0016-5107/2001/$35.00 + 0 37/4/110918 doi:10.1067/mge.2001.110918 EUS in the diagnosis of aberrant subclavian artery

Supernumerary nipple as a cutaneous marker of mitral valve prolapse in Asian Indians

We studied 68 Asian Indians from South India with supernumerary nipple (SN) and 49 age- and sex- matched controls without SN for evidence of mitral valve prolapse (MVP) and associated features. We found that MVP and its forme fruste were more common in the SN group (odds ratio 6.0, 95% confidence intervals 2.16 to 16.63), indicating an association of SN with MVP.

Hypermobility Syndrome

Hypermobility Syndrome

Implications of mitral valve prolapse in children with rheumatic mitral regurgitation

Objectives. This study was conducted to determine the longterm prognosis of children with mitral valve prolapse associated with isolated rheumatic mitral regurgitation.Background. Rheumatic fever may result in mitral valve prolapse, which sometimes leads to severe mitral regurgitation requiring surgical intervention during the active stage of rheumatic fever. However, the influence of mitral valve prolapse on the prognosis of patients with rheumatic mitral regurgitation remains largely unknown.Methods. From 1971 to 1991, 181 children who fulfilled the revised Jones criteria of rheumatic fever were identified from a rheumatic fever prevention program. Of the 181 patients, isolated mitral regurgitation was diagnosed in 123 at age 4 to 12 years. The diagnosis of mitral valve prolapse was based on echocardiographic findings. Actuarial event-free curves for persistent murmur, cardiac improvement and surgical intervention were drawn according to the Kaplan-Meier nonparametric estimation.Results. Evidence of mitral valve prolapse was shown to 37 (30%) of the 123 patients. Patients with mitral valve prolapse were more likely to have a larger cardiac size than those without mitral valve prolapse during the active stage of rheumatic fever. Although the cardiac status of patients with mitral valve prolapse may improve under adequate secondary prophylaxis, an actuarial analysis indicated that patients with mitral valve prolapse had a greater likelihood of murmur persistence and surgical intervention. This trend toward murmur persistence was observed even when patients with heart failure during the active stage of rheumatic fever were excluded from analysis.Conclusions. The presence of mitral valve prolapse in children with isolated rheumatic mitral regurgitation may predict a less favorable outcome.

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.

Effects of hydration on mitral valve prolapse

We investigated the effect of hydration on mitral valve prolapse (MVP). Ten subjects with documented diagnosis of MVP were studied before and after oral hydration with 1 L of fluid. Increased weight and cardiac output were present after hydration. Results showed that all 10 subjects with diagnosis of MVP before hydration continued to have MVP after hydration; however, subtle changes were detected, especially on auscultation. Seven of 9 subjects (with cardiac examination recorded before and after hydration) had auscultatory findings of MVP before hydration. No detectable auscultatory change after hydration was present in one subject; in six subjects a loss of either a click or a murmur was detected after hydration. All subjects had echocardiographically detected MVP before hydration; evidence of MVP on two-dimensional or M-mode examination persisted after hydration in all 10 subjects. Minor changes in the echocardiographic examination (M-mode n = 2, Doppler n = 1) were detected in three subjects. Thus we found that hydration of subjects with MVP did not alter the overall diagnosis; however, changes occurred, especially on auscultation. This suggests that alterations in hydration may affect auscultatory expression of MVP and could explain, in part, the variable auscultatory findings in patients with MVP.

Mechanism of functional mitral regurgitation during acute myocardial ischemia

The mechanism and temporal manifestation of functional mitral regurgitation after acute myocardial ischemia were examined in eight dogs. Regional ischemia was produced by selective micro-embolization of the left circumflex coronary artery. Mitral regurgitation and regional left ventricular wall motion abnormalities were evaluated with use of Doppler color flow mapping and two-dimensional echocardiography, respectively. Measurements were made at baseline (before embolization) and were repeated at 30 min and 3 weeks after embolization.Mitral regurgitation developed in all dogs 30 min after embolization and completely subsided 3 weeks later. There was no evidence of mitral valve prolapse, mitral anulus dilation or left ventricular segmental dyskinesia at any time during the study. Regional wall motion analysis showed only hypokinesia of the left ventricular segment overlying the papillary muscle at 30 min with subsequent normalization of the segment at 3 weeks. Mitral regurgitation was accompanied by an increase of the end-systolic distance between the mitral anulus plane and the point of coaptation of the mitral leaflets. This distance was 0.5 ± 0.1 cm at baseline, increased to 0.9 ± 0.1 cm 30 min after the embolization (p < 0.001) and returned to near baseline (0.6 ± 0.1 cm) 3 weeks after the embolization.These data indicate that mitral valve prolapse, mitral anulus dilation and regional left ventricular dyskinesia are not necessary conditions for the development of functional mitral regurgitation after acute myocardial ischemia. Instead, hypokinesia of the ventricular segment overlying the papillary muscle and leading to retraction of the mitral leaflets toward the apex appears to be a sufficient condition for incomplete leaflet coaptation.

Mitral valve prolapse: cardiac arrest with long-term survival

Cardiac arrest has been reported in patients with mitral valve prolapse; however, clinical characteristics and survival information are limited since most of the cases reported include autopsy data. Nine patients (2 male, 7 female) with mitral valve prolapse were identified who had cardiac arrest; ventricular fibrillation was documented in 8 patients; resuscitation was unsuccessful in 2. Eight had a history of palpitations (months to 15 years duration) and ventricular arrhythmias, 3 had a history (5–15 years) of recurrent syncope, and 1 was totally asymptomatic. Cardiac catheterization-angiographic studies in 8 patients demonstrated normal coronary artery anatomy and mitral valve prolapse. All 9 patients had auscultatory and echocardiographic evidence of mitral valve prolapse. Seven survivors (6 still alive) were followed from 3 to 14 years after cardiac arrest. A subset of patients with mitral valve prolapse and cardiac arrest is described in whom past medical history is compatible with cardiac arrhythmias or syncope, and whose long-term prognosis appears better than patients with other causes of cardiac arrest.

Clinical significance of the echocardiographic degree of mitral valve prolapse

To assess the clinical significance of the echocardiographic degree of mitral valve prolapse, we prospectively evaluated with Doppler echocardiography 246 consecutive patients referred with signs or symptoms consistent with a diagnosis of mitral valve prolapse. The echocardiographic degree of mitral valve prolapse was measured by a scoring system that incorporates an assessment of mitral systolic displacement from the M-mode aa well as the two-dimensional long-axis and apical four-chamber views (range 0 to 9, 0 = no mitral valve prolapse). A structured questionnaire was used to record the frequency and severity of symptoms. Pulsed and continuous-wave Doppler echocardiography were performed to document mitral regurgitation and determine the ratio of peak early to atrial diastolic filling velocities. Patients were grouped according to the degree of mitral valve prolapse; 45 patients had no echocardiographic evidence of mitral valve prolapse. There was no statistically significant relationship between the mitral valve prolapse score and symptoms or left ventricular systolic or diastolic function. There was, however, a strong relationship between the echocardiographic degree of mitral valve prolapse and the presence of significant mitral regurgitation. Patients without echocardiographic evidence of mitral valve prolapse had a 4% incidence of mitral regurgitation, which was not significantly different than that of persons with mild degrees of prolapse (6%). However, the groups with the most marked degree of prolapse (scores of 6, 7, 8, and 9) had a significantly higher incidence of mitral regurgitation (20% and 60% respectively, p < 0.01). Thus the phenomenon of mitral valve prolapse as assessed by echocardiography is a continuous spectrum wherein patients with the most severe degree of prolapse have a proportionately higher prevalence of mitral regurgitation. However, there does not appear to be a relationship between the echocardiographic degree of mitral valve prolapse and either symptoms or left ventricular function.

Ruptured Chordae Tendineae and Acute Pulmonary Edema Induced by Exercise

AUSCULTATORY or echocardiographic evidence of mitral valve prolapse may be present in up to 10% of healthy individuals.^1,2Although mitral valve prolapse is generally considered benign, complications are occasionally associated with this condition, including bacterial endocarditis, embolic phenomenon, arrhythmias, and progressive mitral insufficiency.³A subset of patients with mitral valve prolapse will develop severe mitral insufficiency directly related to rupture of previously intact chordae tendineae. It has been hypothesized that strenuous exertion may predispose to this complication,^4,5but there has been no conclusive clinical evidence to support this concern. This report is the first to our knowledge to describe a patient with mitral valve prolapse who developed acute chordal rupture and pulmonary edema related to vigorous exercise. <h3>Report of a Case</h3> A 26-year-old man was evaluated at another medical center for a "loud" heart murmur, which was discovered during a routine physical examination performed for insurance purposes.

Prevalence of mitral valve prolapse in healthy Saudi women

Two-hundred-and-thirty-two Saudi young women were prospectively clinically examined for the presence of mitral valve prolapse. Phonocardiograms recorded in all subjects at rest in supine position revealed 10.7% incidence of systolic clicks and/or mid to late systolic murmurs. Echocardiographic studies were performed in supine, left lateral as well as sitting up positions. Twenty-eight subjects were found to have mitral valve prolapse. Of these, 21 subjects had mid to late systolic prolapse when the other seven subjects were found to have pansystolic prolapse (holosystolic). Eight of the 28 positive subjects had auscultatory evidence of mitral valve prolapse. It seems that mitral valve prolapse is more common than expected in healthy Saudi women population.

Evaluation of 49 mitral valve prolapse patients for maxillofacial skeletal deformities and temporomandibular joint dysfunction

Forty-nine persons with evidence of mitral valve prolapse (MVP) documented by echocardiogram were used as a marker of diffuse connective tissue disorders to measure the incidence of maxillofacial skeletal deformities and temporomandibular joint (TMJ) dysfunction. Forty-five percent of the MVP patients had TMJ dysfunction; furthermore, 50% of this group had hyperlaxity of the thumb, and a significant number had a Class II molar relationship. This study demonstrates a high incidence of TMJ dysfunction among MVP patients and leads to the suspicion of a common connective tissue disorder.

Evidence for progression from mild to severe mitral regurgitation in mitral valve prolapse

Little information is available concerning the progression of mild to severe mitral regurgitation (MR) in patients with mitral valve prolapse (MVP). This study reports 86 patients, average age 60 years, who presented with cardiac symptoms, precordial systolic murmur, severe MR and a high incidence of MVP on echocardiography (57 of 75 [75%]) and left ventriculography (61 of 84 [73%]). Seventy-five surgically excised mitral valves appeared grossly enlarged and floppy. Histologic studies showed extensive myxomatous changes throughout the leaflets and chordae. Eighty patients had had precordial murmurs first described at average age 34 years, but the average age at which symptoms of cardiac dysfunction appeared was 59. However, once symptoms developed, mitral valve surgery was required within 1 year in 67 of 76 patients who had undergone surgery. Atrial fibrillation, present in 48 of 86 patients (56%), or ruptured chordae tendineae, present in 39 of 76 patients (51%), may have contributed to this rapid progression and deterioration. Additionally, 13 patients had a remote history of documented infective endocarditis. Twenty-eight patients had at least 1 type of serial clinical evaluation that indicated progressive MR in all 28 patients on the basis of changing auscultatory findings (24 of 26), progressive radiographic cardiomegaly (24 of 25), echocardiographic left atrial enlargement (4.3 to 5 cm in 11 patients) and angiographically worsening MR (14 of 15). Twenty-four of these patients had evidence of MVP on at least 1 of their initial studies. Thus, mild MR due to MVP and myxomatous mitral valves is a progressive disease in some patients with MVP.

Mitral Valve Prolapse

Mitral valve prolapse (MVP) is a common condition that is believed to be responsible for numerous symptoms and potentially serious complications. To determine whether symptoms and functional impairment are related to MVP itself, we studied 274 outpatients referred to an echocardiography laboratory for suspicion of MVP. The age, sex, and symptoms at the time of echocardiography were similar among patients with and without evidence of MVP. After 14 to 36 months, 158 patients were interviewed. There was a high rate of dysfunction, but echocardiographic evidence of MVP was not associated with disability, health care utilization, or reported symptoms. The results of this study suggest that symptoms and dysfunction are not related to the presence of MVP by echocardiography. The functional impairment that is seen in patients suspected of MVP may be caused by other factors.

Complex ventricular arrhythmias associated with the mitral valve prolapse syndrome. Effectiveness of moricizine (ethmozine) in patients resistant to conventional antiarrhythmics

On the basis of epidemiologic studies, more than 10 million Americans have echocardiographic evidence of mitral valve prolapse. Although ventricular arrhythmias occur frequently (over 50 percent of patients with mitral valve prolapse), they rarely result in sustained ventricular tachycardia or sudden cardiac death. However, a common problem in clinical practice is a patient with mitral valve prolapse and symptomatic complex ventricular arrhythmias refractory or intolerant to both beta blockers and conventional type I antiarrhythmics. These drugs are known to have frequent side effects, toxicity, and proarrhythmic effects. In 17 patients with mitral valve prolapse who presented with symptomatic complex ventricular arrhythmias and who were unresponsive to an average of three conventional agents, moricizine (Ethmozine) was effective in suppressing 90 percent of ventricular premature depolarizations, 99 percent of nonsustained runs of ventricular tachycardia, as well as all sustained runs of ventricular tachycardia, resulting in abolition of palpitations, dizziness, and syncopal episodes. Its efficacy as well as its low frequency of minor side effects makes it ideal for future consideration in the population with mitral valve prolapse, who are frequently young and may therefore require therapy for many years.

Aortic root dilatation and mitral valve prolapse in the fragile X syndrome.

Forty patients with fragile X [fra(X)] or Martin-Bell syndrome, confirmed by chromosome analysis, underwent full cardiac evaluation including physical examination, chest film, electrocardiography (ECG), and M-mode and 2-dimensional echocardiography. Thirty-four males and six females were studied. Although all patients were asymptomatic, seven males were found to have mild aortic root dilatation. All seven also had evidence of mitral valve prolapse. Twenty-two (55%) of the study patients had mitral valve prolapse with either a click or murmur heard on physical examination and confirmation by M-mode echocardiography. The frequency of mitral valve prolapse was the same in males and females, but 80% of males older than 18 years had mitral valve prolapse. These findings support the hypothesis of a connective tissue dysplasia in the fra(X) syndrome.

M-mode echocardiography in supine and standing position in control subjects and patients with auscultatory evidence of mitral valve prolapse but negative supine echocardiography: does sensitivity improve?

Approximately 10-20% of patients with auscultatory evidence of mitral valve prolapse (MVP) have "false negative" echocardiograms. Pharmacological maneuvers do not significantly improve the sensitivity and may cause side effects. It is well known that auscultatory features of MVP change and not uncommonly can be heard only in the standing position. Therefore M-mode echo was performed in both supine and standing positions in 10 normal control subjects and 25 patients of comparable age and sex who had auscultatory evidence of MVP but negative echo in supine position. All 10 control subjects had normal echo in both supine and standing positions. No instance of false positive MVP was noted. Of the 25 patients with "false negative" supine echo, 5 showed evidence of MVP (3 pansystolic and 2 late systolic) in standing position. Based on these results the following conclusions were reached. In normal individuals the MVE remains uninfluenced by change in posture. There is modest (20%) improvement in sensitivity of detecting MVP when M-mode echo is performed in standing position in addition to supine position. Change in posture is preferable to the use of pharmacological maneuver to improve the sensitivity of detecting MVP because it is physiological, devoid of any cost, and does not produce side effects. M-mode echo in standing position or two-dimensional echo in supine position can be used to confirm the diagnosis of MVP in those patients who have "false negative" and/or nondiagnostic supine echo in the presence of auscultatory features of midsystolic click and mid- or late-systolic murmurs.