Idiopathic Mitral Valve Prolapse Research Articles

QT interval analysis in individuals with idiopathic mitral valve prolapse

Objectives: The goals of the study are to determine whether or not there is a correlation between the QT interval and IMVP, to provide an explanation for sudden cardiac death in some cases, and to show how IMVP symptoms are linked to certain arrhythmias.
 Methods: QTC intervals were measured in 43 patients with idiopathic mitral valve prolapse (11 men and 32 women with mean age 46±17 years). All patients underwent a clinical and echocardiographic examination, and ECG taking to assess the incidence of long QT in patients with IMVP.
 Results: The data show that 36 of the 43 patients with IMVP have a prolonged QT interval, while only 2 of the 38 patients in the control group have. There was also an uptick in arrhythmia cases when the QT interval was prolonged.
 Conclusion: Individuals with IMVP have an increased risk of arrhythmias, and this risk is even greater in patients with very long QT, which can cause life-threatening ventricular arrhythmias, as shown by this study.

Hypersensitivity pneumonitis against the background of the use of organic substances, probably mustard powder (clinical case)

We describe a clinical case of hypersensitivity pneumonitis against the background of the use of organic substances, probably mustard powder.Patient K. is 18 years old and lives in the city. The disease began on 01.11.2022, with complaints of cough with difficult secretion of thick sputum, shortness of breath with slight physical exertion, an increase in body temperature to 37.5 °C, a feeling of palpitations. Complaints were observed for about three weeks and increased in dynamics. Consulted a pulmonologist at a private medical center, where a diagnosis of allergic bronchitis was made and treatment was prescribed, which did not have a positive effect. On 21.11.2022, the family doctor referred him for an X-ray examination, where pathological changes in the lungs were detected. The patient was referred to a pulmonologist for consultation, and a computed tomography (CT) of the chest was also performed. Changes characteristic of hypersensitivity pneumonitis were detected, hospitalized in the pulmonology department of the Ternopil Regional Phthisiopulmonological Medical Center. It is known from the anamnesis that for about three months he worked in the production of food products where mustard powder was used, he did not use respiratory protection means.Additional examination methods were carried out. Bronchoscopy, conclusion — Catarrhal laryngitis, diffuse bilateral catarrhal tracheobronchitis. Computed tomography of the chest organs dated 22.11.2022, the conclusion is that the picture of the dissemination syndrome in the lungs is more characteristic of acute hypersensitivity pneumonitis. The patient was consulted by a cardiologist. The clinical diagnosis «Hyper­sensitive pneumonitis against the background of the use of organic substances, probably mustard powder, subacute form, diagnosed for the first time. Pulmonary insufficiency of the 2nd degree. Idiopathic mitral valve prolapse. Metabolic cardiomyopathy. Heart failure of the 0th stage». Treatment is prescribed. 09.12.2022 discharged for outpatient treatment with improvement. According to the data of the control examination (CT dated 09.01.2023) dynamics of partial resorption of hypersensitivity pneumonitis.

Magnesium in Idiopathic Mitral Valve Prolapse

Abstract The aim of our research was to increase the effectiveness of the therapy administered to the patients with idiopathic mitral valve prolapse by pharmacological correction of magnesium deficiency. 79 patients (23 females and 56 males with average years of age 35.7±4.3 ) with undifferentiated connective tissue dysplasia and mitral valve prolapse of the 1st and 2nd degree were examined. The control group consisted of 20 healthy individuals, comparable by sex and age. A test by the UNESCO Institute for Microelements was used for the preliminary diagnostics of magnesium deficiency. Daily ECG monitoring with heart rate variability analysis, echodopplercardiography with the assessment of left ventricular diastolic function and determination of magnesium concentration in blood serum were performed. For the demonstration of autonomic dysfunction “the test for detection of the signs of vegetative changes” was used (10). For the assessment of situational and personal anxiety an “anxiety test” by Ch. D. Spielberg and Y. L. Hanin (25, 26) was used. The succeeding study was performed after 6 months. It was found that complex therapy with magnesium orotate in patients with idiopathic mitral valve prolapse helps to reduce the frequency of clinical manifestations of neurovegetative disturbances in the majority of examined patients contributing to harmonization of the autonomic nervous system function. It has a favorable effect on dysplastic changes and the state of bioelectrical activity of the heart, as well as correction of the psychoemotional state.

CORRECTION OF ELECTROLYTE DISTURBANCES IN PREGNANT WOMEN WITH MITRAL VALVE PROLAPSE

Idiopathic mitral valve prolapse in pregnant women has a more severe duration, associated with higher incidence of various cardiovascular and obstetric complications, accompanied by a number of phenotypic and visceral abnormalities that can be inherited to the child, that demonstrates a higher overall clinical significance of mitral valve prolapse precisely for pregnancy. The deficiency of vitamins, micro- and macroelements in these patients negatively predetermines the course of pregnancy and requires additional compensation for their deficiency.The purpose of the study was to investigate the importance of electrolyte disturbances as predictors of development of obstetric and perinatal complications in pregnant women with mitral valve prolapse and cardiac rhythm disturbances and to evaluate the effectiveness of their correction by using preventive use of a balanced vitamin and mineral complex Emfetal.Materials and methods. The study included 98 pregnant women with idiopathic (primary) cardiac arrhythmia in the form of supraventricular or ventricular extrasystoles. 78 patients received detailed nutrition and physical activity recommendations and used a balanced vitamin-mineral complex Emfetal by 1 pill 2 times a day in two courses for 28 days in the gestation period of 15-16 and 28-29 weeks. The comparison group included 20 pregnant women with mitral valve prolapse and arrhythmia who did not receive vitaminelectrolyte treatment. The control group consisted of 20 healthy pregnant women.Results. The analysis of pregnancy and childbirth in the main group of women has shown that women with cardiovascular risk factors (mitral valve prolapse, heart rhythm disturbance) during pregnancy have significantly more complications than in the general population. The gestational process was more often complicated by miscarriage, the development of placenta dysfunction, anemia, preeclampsia, fetal growth retardation syndrome. The development of the above-mentioned complications of pregnancy could be facilitated by the low concentration of ionized micronutrients and some vitamins in blood plasma level of these patients as it should be needed for normal fetal and physiological pregnancy development. At the same time, a decrease in blood plasma levels of vitamin C, important ionized macro- and microelements such as magnesium, iodine, selenium, iron were detected in these pregnant women during the laboratory biochemical study. In this case, the presence of mitral valve prolapse complicated by cardiac arrhythmias in pregnant women is associated with relative hypomagnesaemia. It is the disturbance of the normal balance between the Mg2+ and K+ ions can serve as a marker not only for cardiac rhythm disturbances but also as a predictor of the development of other obstetric and perinatal complications in pregnant women with mitral valve prolapse. Using the balanced vitamin-mineral complex Emfetal in pregnant women with mitral valve prolapse and extrasystoles is accompanied by a significant decrease of the patients with arrhythmia (by 55.1 %) and daily number of extrasystoles based on the results of the Holter heart rate analysis.Conclusions. Pregnancy in women with cardiovascular risk factors, such as mitral valve prolapse and cardiac arrhythmias is often complicated by the development of placental dysfunction (60.0%), early miscarriage (30.0%), anemia (75.0%), preeclampsia (30.0%), fetal growth retardation syndrome (10.0%). Decrease in magnesium level below 0.62 ± 0.04 mmol/l while decreasing the normal serum Mg2+ / Ca2+ and Mg2+ / K+ ratio is associated as with the development of cardiac arrhythmias in the form of extrasystolic arrhythmia, as a high rate of pregnancy complications. Using of the balanced vitamin-mineral complex (emphetal), therapeutic and prophylactic measures contributes to a significant decrease in the daily amount of extrasystoles and the frequency of development of severe pregnancy complications.

Therapeutic potential of the tetramethyltetraazabicyclooctandione with idiopathic mitral valve prolapse

The purpose of the study is to increase the effectiveness of treatment of young people with idiopathic mitral valve prolapse (IMVP) and clinical signs of autonomic dysfunction.Materials and methods. We examined 79 patients (mean age 35.7±4.3 years) with PMK and phenotypic signs of undifferentiated connective tissue dysplasia (DST). The control group consisted of 20 practically healthy persons, comparable by gender and age. All patients were evaluated for clinical status, echo doppler cryography on the «LOGIQ 5» («Medical System», Germany) ultrasound diagnostic scanner. To identify vegetative dysfunction, «Questionnaire used to identify signs of vegetative changes» (Wayne A. M., 2003). To assess situational and personal anxiety, an anxiety questionnaire by C. D. Spielberger (1973) was used in the adaptation of Yu. L. Hanin. Non-specific changes in the functional state of the central nervous system were studied by the indirect registration of the heart rate variability in the cardiographic complex of Holter monitoring «Cardiosens» («KhAI Medica», Ukraine). After the survey at baseline, patients were divided into 2 groups. In the I group 39 patients were enrolled, which was prescribed a complex therapy, which included β-adrenoblocker and mebirum – Adaptol (JSC «Olain KhFZ» «Olainfarm», Latvia) 500 mg 3 times a day for 3 months. In group II, 40 people were enrolled with monotherapy with β-blockers. These groups of patients with PMP and autonomic dysfunction were comparable in age and gender. Statistical processing of the results of the study was conducted using the software package Statistica 6.0 for Windows.Results. After course treatment in the main group, a significant (p <0.05) decrease in the frequency of clinical manifestations of neurolective disorders was noted in 94.9 % of the examined patients. Clinically significant reduction of the expression of the syndrome of vegetative dystonia was noted in 79.5 % of patients in group I and in 47.5 % of group II (p<0.05). According to self-esteem for AM Wayne (2003), the amount of points in group I decreased from 45.7±2.5 to 16.8±2.1 points (p <0.001), in group II – from 45.9±2.3 to 29.3±2.1 (p <0.001) points. The reduction of the voltage index in the I group was established by 66.9% (p <0.05), in the II group – by 47.3 % (p<0,05); the index of fashion amplitude - by 33.3 % (p<0,05) and 16,5 % (p<0,01); an increase in the variational scale by 64.1 % (p<0.05) and 38.4 % (p<0.01) respectively. In SD group, SDNN increased by 27.5 % (p <0.05), in group II – by 8.8 % (p>0.05), the RMSSD in group I increased by 27.9 % (p<0,05), in group II – by 8,47% (p> 0,05); the pNN 50 in the I group increased by 27.3 % (p<0.05), in the II group – by 11.7% (p>0.05), respectively. There was a marked decrease in reactive anxiety level by 36.7 % (p<0.001) and personal anxiety by 38.9 % (p<0.001), with the addition of adaptol therapy was the most effective in the group with high and average anxiety. Undesirable effects of adaptol during the course of treatment have not been noted.Conclusions. The inclusion of an adaptol in the complex therapy of young people with idiopathic PMC leads to a complete or almost complete reduction of clinical symptoms, a significant improvement in the parameters of the heart rate variability, which is manifested in lowering the stress index and restoring the autonomic balance with the temporal parameters of the heart rate variability, as well as reducing the level of reactive anxiety, which allows to increase the functional capabilities of the body against the background of improving the psycho-emotional state, along with a good tolerability profile and without pitchers

The changing epidemiology and clinical features of infective endocarditis: A retrospective study of 196 episodes in a teaching hospital in China

BackgroundInfective endocarditis is an uncommon but life-threatening infectious disease. To our knowledge, current investigations of the characteristics of infective endocarditis in our region are scarce. In this study, we aimed to investigate the changes in the epidemiology and clinical features of infective endocarditis.MethodsA retrospective analysis of clinical data was performed using 196 infective endocarditis cases diagnosed between June 2004 and December 2012 at The First Affiliated Hospital of China Medical University. A comparative analysis of clinical risk factors was also included.ResultsThe mean age of the patient cohort was 43.5 (29.0–55.8) years old. Of the 196 cases studied, 128 cases (65.3%) were left native valve infective endocarditis, 13 cases (6.6%) were left prosthetic valve infective endocarditis, and 47 cases (24%) were right valve infective endocarditis. In addition to natural valve endocarditis, many patients also exhibited various types of cardiopathy: 72 cases (36.7%) had congenital cardiovascular malformations, 37 cases (18.9%) had idiopathic mitral valve prolapse and 31 cases (15.8%) had no significant cardiac disease. The primary clinical manifestations that were observed included 168 cases with fever (85.7%), 131 cases with anemia (66.8%), 114 cases with hematuria (58.2%) and 58 cases with splenomegaly (29.6%). Positive blood cultures were detected in 96 cases (49%); the most commonly detected organism was Streptococcus viridans (41 cases; 42.7%), followed by 18 cases (18.8%) of Staphylococcus aureus and 10 cases (10.4%) of Enterococcus. With respect to risk factors, infection with Staphylococcus aureus or gram-negative bacilli (OR = 18.81, 95%CI = 2.39–148.2), congestive heart failure (OR = 8.854, 95%CI = 1.34–54.7), diabetes (OR = 7.224, 95%CI = 1.17–44.7) and age ≥ 60 years (OR = 6.861, 95%CI = 0.94–50.1) were major prognostic risk factors.ConclusionInfective endocarditis is more common than previously believed, but there are regional differences with respect to the epidemiological and clinical characteristics of infective endocarditis, and its etiology is diverse and complicated. Our study of the clinically diagnosed cases of infective endocarditis verified the regional characteristics of infective endocarditis using a straightforward retrospective analysis. The geographic variations we observed in the study will be of important value to clinical diagnosis in our region.

BIOCHEMICAL MARKERS OF UNDIFFERENTIATED DYSPLASIA OF CONNECTIVE TISSUE IN PATIENTS WITH IDIOPATHIC MITRAL VALVE PROLAPSE

The complex clinical and instrumental examination of 120 patients with idiopathic mitral valve prolapse was conducted. The group of comparison consisted of 30 patients with undifferentiated connective tissue dysplasia without mitral valve prolapse. There were analysed changes in the levels of magnesium, adrenal cortex hormones (aldosteron, cortisol), amino acid composition in blood serum, identified patterns between these changes and clinical displays, degree of mitral valve prolapse, the frequency of detection the heavy arrhythmias, and selected groups of risk among patients.

Effektivnost' primeneniya preparata«Magnerot®» pri proyavleniyakh sindromasosudistykh narusheniy i gemorragicheskogosindroma u bol'nykh s idiopaticheskimprolapsom mitral'nogo klapana

Summary. Aim. To evaluate the efficiency of placebo-controlled magnerot use on vascular and hemorrhagic manifestations in patients with idiopathic mitral valve prolapse (MVP). Subjects and methods. Seventy-four patients (31,7% males and 68,3% women) with idiopathic MVP were examined during a single-blind placebo-controlled study. They were randomized into 2 groups: 1) magnerot (a study group) and 2) placebo (a control group). The mean age of the study group patients was 30,80,4 years. The placebo group was matched by age (mean age 31,10,2) and gender. There was a female preponderance among the examinees in both groups. The study group patients received MagnerotR tablets containing 500 mg of Mg orotate (32,8 Mg of elementary Mg) in a daily dose of 3000 mg (196,8 mg of elementary Mg) for 6 months. All the patients underwent comprehensive examination before and 6 months after the study. Results. A clinical significant reduction in the degree of vascular disorders was noted in 71,3% of the patients with MVP. The incidence of vascular disorders remained virtually unchanged in the study group. Vascular disorders were significantly alleviated after the therapy. If before the therapy, mild, moderate, and severe vascular disorders were diagnosed in 30,2, 55,9, and 13,9% of cases, respectively; whereas after the therapy these were absent in 16,3% of cases; the patients with mild vascular disorders increased by 2,5-fold and their severe form was undetected. The clinical effect of the therapy on the severity of hemorrhagic syndrome was observed in 81,4% of patients (75% males and 89,5% females) and the therapeutic efficiency that very frequently corresponded to clinical improvement was seen in 2,3%. Conclusion. The effect of magnerot therapy is shown to significantly reduce the incidence and degree of vascular disorders and hemorrhagic syndrome and their clinical picture as a whole.

Predictors of Outcome of Mitral Valve Prolapse in Patients With the Marfan Syndrome

Mitral valve prolapse has a prevalence of 2% to 3% in the general population, with adverse outcomes such as mitral valve regurgitation (MVR), heart failure, and endocarditis. Predictors of outcomes are used in idiopathic mitral valve prolapse for the timing of surgery, but such predictors are unknown in Marfan syndrome. Therefore, a population-based cohort study of 112 patients (49 male, 63 female; mean age 34 ± 15 years) with classic Marfan syndrome and mitral valve prolapse with moderate or less MVR at baseline was conducted. During 4.6 ± 3.6 years of follow-up, progression of MVR was observed in 41 patients and valve-related events, which comprised mitral valve endocarditis (7 events), heart failure (5 events), and mitral valve surgery (25 events), were observed in 31 patients. Multivariate Cox proportional-hazards regression analysis identified a flail mitral leaflet (hazard ratio [HR] 3.262, 95% confidence interval [CI] 1.406 to 7.566, p = 0.006) and increased indexed end-systolic left ventricular diameters (HR 1.113, 95% CI 1.043 to 1.188, p = 0.001) as independent predictors of progression of MVR. Similarly, mitral valve-related events were independently predicted by a flail mitral leaflet (HR 5.343, 95% CI 2.229 to 12.808, p <0.001), and mild (HR 14.336, 95% CI 1.873 to 109.755, p = 0.01) or moderate (HR 16.849, 95% CI 2.205 to 128.76, p = 0.006) degree of MVR. Conversely, aortic dilatation, dural ectasia, and sporadic mode of inheritance were not associated with outcome. In conclusion, the same clinical determinants that predict outcomes in idiopathic mitral valve prolapse also predict outcomes in mitral valve prolapse associated with Marfan syndrome.

Degenerating Heart Valves

The intellect is always fooled by the heart. — - La Rochefoucauld Myxoid valvular heart dystrophies are a frequent cause of valvular diseases. They affect approximately 3% of the population and are the most common cause of isolated mitral regurgitations that require surgical repair.1,2 These valvular diseases are a heterogeneous group of disorders and include isolated nonsyndromic valvular diseases, such as idiopathic mitral valve prolapse and the X-linked myxomatous valvular dystrophy (XMVD), and syndromic entities, such as Marfan syndrome. In this issue of Circulation , Kyndt et al3 report their surprising finding that specific mutations in filamin A (FLNA) , a gene previously associated primarily with neurological and skeletal disorders, actually cause XMVD. Article p 40 XMVD is a rare form of inherited nonsyndromic valvular dystrophy that was identified more than 30 years ago by Monteleone and Fagan.4 Initial reports suggested that only men could be affected, but a subsequent study revealed that the disease has heterogeneous presentations and that women can have milder manifestations.5 Histologically, the valves classically display abnormalities of myxomatous degeneration, with fragmentation of collagen bundles within the valve fibrosa and accumulation of proteoglycan and secondary calcification. The clinical spectrum of XMVD ranges from isolated mild valve defects to severe multivalvular lesions, but XMVD usually affects the mitral and/or aortic valve. The result is mitral valve prolapse and mitral and/or aortic regurgitation. Affected individuals are usually asymptomatic until valvular lesions progress to significant hemodynamic impairment and heart failure. Complications can include endocarditis, spontaneous chordal rupture, and sudden death.5,6 Mutations of fibrillin and collagen genes have been correlated with syndromic cases of myxoid valvular heart dystrophies (eg, as part of Marfan and Ehlers–Danlos syndromes),7,8 but until now, no specific gene had been identified for nonsyndromic valvular dystrophies. Idiopathic mitral valve prolapse exhibits …

Relationship between IFN-gamma production by blood lymphocytes and constitutional personality features of patients with idiopathic mitral valve prolapse.

Psychological testing using Eysenck Personality Inventory and immunological testing of 75 patients with idiopathic mitral valve prolapse revealed low production of interferon-gamma by blood lymphocytes and a correlation between interferon-gamma production and patient's temperament. Low neuroticism and extroversion scores were found in patients with normal interferon-gamma production. High neuroticism score was detected in 82% patients with lowest interferon-gamma production, which refers these patients to a group at high immunological risk and prompts the use of interferon and/or its inductors in complex therapy of these patients.

Clinical characteristics of a familial inherited myxomatous valvular dystrophy mapped to Xq28

OBJECTIVESThe purpose of this study was to describe the phenotypic characteristics of an inherited myxomatous valvular dystrophy mapped to Xq28.BACKGROUNDMyxomatous valve dystrophies are a frequent cause of valvular diseases, the most common being idiopathic mitral valve prolapse. They form a group of heterogeneous diseases difficult to subclassify. The first mapping of the gene for a myxoid valvular dystrophy to Xq28 allowed investigation of the phenotype of affected members in a large family and characterization of the disease.METHODSAmong the 318 members in the pedigree, 89 agreed to participate in this study. Phenotypic characteristics were investigated using clinical examination, transthoracic echocardiography and biological analysis (F.VIII activity). Genetic status was based on haplotype analysis.RESULTSAmong 46 males, 9 were hemizygous to the mutant allele and had an obvious mitral and/or aortic myxomatous valve defect, and 4 had undergone valvular surgery. All had typical mitral valve prolapse associated in six cases with moderate to severe aortic regurgitation. The valve defect cosegregated with mild hemophilia A (F.VIII activity = 0.32 ± 0.05). The 37 remaining males had normal valves and normal F.VIII activity. Heterozygous women were identified on the basis of their haplotypes. Among the 17 women heterozygous to the mutant allele, moderate mitral regurgitation was present in 8, associated with mild mitral valve prolapse in 1 and aortic regurgitation in 3, whereas 2 women had isolated mild aortic regurgitant murmur. In heterozygotes, the penetrance value was 0.60 but increased with age.CONCLUSIONX-linked myxomatous valvular disease is characterized by mitral valve dystrophy frequently associated with degeneration of the aortic valves affecting males and, to a lower severity, females. The first localization of a gene for myxomatous valvular diseases is the first step for the subclassification of these diseases.

Long-Term Site-Related Differences in the Progression and Regression of the Idiopathic Mitral Valve Prolapse Syndrome

The natural history of uncomplicated mitral valve prolapse (MVP) is not clearly understood. To determine the site-related differences in regression and progression of MVP, 112 patients with idiopathic MVP were enrolled in this echocardiographic follow-up study. Cardiovascular complications, including dysarrhythmias (n = 3, 2.7%), overt congestive heart failure (n = 4, 3.6%), progression of mitral regurgitation over one grade (n = 28, 25.0%), newly confirmed chordal rupture (n = 1, 0.9%), and surgical repair (n = 2, 1.8%), were observed in these patients during a follow-up period of 1–13 years (mean, 4.0 ± 2.8 years). Multivariate analysis and Kaplan-Meier analysis revealed that posterior leaflet prolapse and significant mitral regurgitation (grade ≥2) were considerable risks for cardiovascular complications. Regression of MVP was seen in 17 (18.7%) of the anterior prolapse patients; however, new prolapse was observed in 40 (35.7%) patients, mainly in posterior prolapse patients. These results suggest that site-related differences exist in uncomplicated MVP prognosis and that MVP in the posterior leaflet has a poor outcome compared to that in the anterior leaflet.

Mapping of X-Linked Myxomatous Valvular Dystrophy to Chromosome Xq28

Myxoid heart disease is frequently encountered in the general population. It corresponds to an etiologically heterogeneous group of diseases, idiopathic mitral valve prolapse (IMVP) being the most common form. A rarely observed form of myxoid heart disease, X-linked myxomatous valvular dystrophy (XMVD), is inherited in an X-linked fashion and is characterized by multivalvular myxomatous degeneration; however, the histopathological features of the mitral valve do not differ significantly from the severe form of IMVP. In this article, we describe the genetic analysis of a large family in which XMVD is associated with a mild hemophilia A. The coagulation factor VIII gene position in Xq28 provided a starting point for the genetic study, which was conducted by use of polymorphic markers. Two-point linkage analysis confirmed this localization, and a maximum LOD score of 6.57 was found at straight theta=0 for two polymorphic microsatellite markers, INT-3 and DXS1008, the first one being intronic to the factor VIII gene. Haplotype analysis of this chromosomal region allowed the definition of an 8-cM minimal interval containing the gene for XMVD, between DXS8011 and Xqter.

Predisposing factors for severe mitral regurgitation in idiopathic mitral valve prolapse

To elucidate predisposing factors for severe mitral regurgitation (MR) in idiopathic mitral valve prolapse (MVP), 124 MVP patients were classified into the following categories: 55 with isolated clicks (click group), 35 with a late-systolic murmur (late-SM group), and 34 with a holosystolic murmur (holo-SM group). Their clinical and echocardiographic findings were compared with those of 26 patients with spontaneous chordal rupture (rupture group). In 22 patients in the click group, 24 in the late-SM group, and 22 in the holo-SM group, follow-up studies were performed for a mean of 4.5 years (range 1 to 13.5). The mean age was youngest in the click group and oldest in the rupture group. The click and late-SM groups showed a female predominance, but the holo-SM and rupture groups showed a male predominance. There was no difference in the incidence of systemic hypertension among the 4 groups. Most patients in the click and late-SM groups had anterior leaflet prolapse. In the holo-SM and rupture groups, however, the incidence of posterior leaflet involvement was significantly increased. The incidence of thickened mitral valve increased in order of the click (8%), late-SM (21%), holo-SM (38%), and rupture (50%) groups. Six patients in the holo-SM group developed chordal rupture with severe MR during the follow-up period. In the click and late-SM groups, however, there were no complications and no development into a holo-SM. Thus, aging, male sex, posterior leaflet prolapse, thickened mitral valve, and holo-SM were round to be important predisposing factors for severe MR in idiopathic MVP.

P-wave signal-averaged electrocardiogram in patients with idiopathic mitral valve prolapse syndrome and supraventricular arrhythmias

The aim of the study was to assess whether the P-wave triggered signal-averaged ECG (SAECG) used in patients with idiopathic mitral valve prolapse syndrome could predict the risk of the development of supraventricular arrhythmias. Fifty patients with idiopathic mitral valve prolapse syndrome (15 men, 35 women, mean age: 37 ± 9 years) were prospectively studied. P-wave triggered SAECG was recorded with a commercially available system (HIPEC-200HA Aerotel). The following parameters were calculated: the root-mean-square voltage for the terminal 10, 20, 30 ms of filtered P-wave (RMS10,20,30) and time duration of filtered P-wave (PWD). Nine patients with mitral valve prolapse syndrome (18%) revealed the occurrence of supraventricular arrhythmias on Holler monitoring whereas of the remaining 41 (82%), no clinically relevant supraventricular arrhythmias were detected. We found PWD values to be significantly longer in patients with supraventricular arrhythmias when compared with those without arrhythmias: 119.8 ± 6.9 ms vs. 111.7 ± 12.1 ms, respectively, P < 0.02. We conclude that P-wave triggered SAECG could be a useful technique for detecting patients with idiopathic mitral valve prolapse syndrome at risk of paroxysmal supraventricular arrhythmias.

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.

Left ventricular diastolic filling alterations in subjects with mitral valve prolapse: a Doppler echocardiographic study

To assess left ventricular diastolic filling in mitral valve prolapse (MVP), we studied 22 patients with idiopathic MVP and 22 healthy controls matched for sex, age, body surface area and heart rate. A two-dimensional, M-mode and Doppler echocardiographic examination was performed to exclude any cardiac abnormalities. The two groups had similar diastolic and systolic left ventricular volumes, left ventricle mass and ejection fraction. Doppler measurements of mitral inflow were: E and A areas (the components of the total flow velocity-time integral in the early passive period of ventricular filling, E; and the late active period of atrial emptying, A), the peak E and A velocities (cm.s-1), acceleration and deceleration half-times (ms) of early diastolic rapid inflow, acceleration time of early diastolic flow (AT), total diastolic filling time (DFT) (ms), and the deceleration of early diastolic flow (cm.s-2). From these measurements were calculate: peak A/E ratio (A/E), E area/A area, the early filling fraction, the atrial filling fraction, AT/DFT ratio. All the Doppler measurements reported are the average of three cardiac cycles selected at end expiration. The mean peak A velocity, A/E velocity ratio, deceleration half time and atrial filling fraction were each significantly higher for subjects presenting a MVP (60 +/- 12 cm.s-1 vs 49 +/- 14, P < 0.008; 98 +/- 13% vs 64 +/- 12%, P < 0.0001; 120 +/- 36 ms vs 92 +/- 11, P < 0.002; 0.45 +/- 0.14 vs 0.36 +/- 0.08, P < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical and exercise echocardiographic findings in patients with mitral valve prolapse.

To assess the relationship between left ventricular functional reserve and prognosis in patients with idiopathic mitral valve prolapse, ergometer exercise echocardiography was performed in 10 normal subjects and 30 patients with mitral valve prolapse having either mild, or no mitral regurgitation. These 30 patients with mitral prolapse were followed for 2 to 8 (mean 4.5) years. Increment of % fractional shortening during maximum exercise at the initial study in patients with mitral valve prolapse and normal subjects were 7 +/- 7 and 11 +/- 3%, respectively. Based on increment of % fractional shortening, patients with mitral valve prolapse were divided into 2 groups; Group I: 13 cases with delta% fractional shortening less than 5%, Group II: 17 cases with delta% fractional shortening greater than or equal to 5%. The incidence of cardiac symptoms was higher in Group I than in Group II (85 vs 41%, p less than 0.05). ST-T changes and life-threatening arrhythmias were more frequently observed in Group I. During the follow-up period, M-mode echocardiographic measurements did not vary in Group II, but left ventricular and left atrial dimensions increased significantly (p less than 0.05, p less than 0.01, respectively) and % fractional shortening decreased significantly (p less than 0.01) in Group I without any change in mitral regurgitation severity. Thus, some patients with mitral valve prolapse not having significant mitral regurgitation may develop progressive deterioration of the cardiac function, which may be predicted by exercise echocardiography.

Prevalence of QTc prolongation in women with mitral valve prolapse

This report defines the prevalence of QTc prolongation in women with idiopathic mitral valve prolapse (MVP). Prolongation of the QTc interval in patients with MVP has been reported in several studies. 1–5 The incidence in these studies has been variable, ranging from 91 1 to 26%. 5 Not all investigations, however, have found a correlation between MVP and prolonged QTc intervals. 6,7 The Framingham study revealed no evidence of QT prolongation in association with MVP. 8 The incidence of QTc prolongation has clinical significance because several investigators have implied a relation between this repolarization abnormality and sudden death in patients with MVP. 9,10