Severe Mitral Valve Prolapse Research Articles

One stone, two birds: severe left ventricular outflow tract obstruction and mitral valve prolapse treated with one single ValveClamp.

One stone, two birds: severe left ventricular outflow tract obstruction and mitral valve prolapse treated with one single ValveClamp.

Mitral Valve Prolapse, Not Always an Easy Diagnosis

Abstract We present the case of a 61-year-old male patient, with no medical history, who was presenting for an anterior chest pain, which appeared suddenly during an effort, accompanied by palpitations, fatigue and dyspnea Physical examination revealed the presence of a 4/6 systolic murmur with maximal auscultation at the apex and radiation in the left axilla. Echocardiographic evaluation revealed diagnostically suggestive elements for severe posterior mitral valve prolapse without any rupture, color Doppler showing severe mitral regurgitation, a tricuspid valve prolapse, tricuspid regurgitation grade III and pulmonary hypertension. Coronary angiography revealed coronary arteries without hemodynamically significant lesions, and Holter ECG/24-hour monitoring detected atrial fibrillation in 44% of the monitoring time. In this context, the possible causes of the anterior chest pain were: microvascular angina, traction on the chordae or pulmonary hypertension. The patient had a surgical indication for mitral valve replacement or reconstruction. The department of cardiac surgery undergoes mitral valve replacement with a mechanical prosthesis with a favorable outcome.

Evaluation of Early Repolarization Pattern in Children with Mitral Valve Prolapse.

Patients with mitral valve prolapse (MVP) may be prone to ventricular arrhythmias and sudden cardiac death and presence early repolarization pattern (ERP) in electrocardiography may be predict for ventricle arrhythmia. This study aimed to evaluation ERP in Children with MVP. In a cross-sectional study, we enrolled ERP in 70 MVP children with 70 age-and sex-matched healthy individuals. After echocardiography procedure for confirmation MVP, standard 12-lead electrocardiography recordings with sweeping rate of 25mm/s and an amplitude of 10mV/cm, and two cardiologists assessed who were blinded to the both groups. We detected ERP in 17.14% of MVP patient's and seen in 8 case (11.43%) in control group, (P=0.23). the ERP occurred in MVP patient's mild, moderate and severe 4, 6 and 2 cases, (P=0.29). The ERP found in patients with and without chest pain 13 and 7, respectively (P=0.46) and, in patients with and without palpitations 15 and 5 cases, respectively (P=0.24). The ERP occurred 1.6 time more in patient with MVP in comparing with individual without MVP. The ERP occurred more frequently in among patients with moderate MVP in comparing with severe and mild. Chest pain and palpitation occurred more frequently in among patients with severe MVP. The prevalence of ERP in children with MVP has been at a higher-level incidence, especially among patients with complaining from chest pain. We suggested that children with MVP are in need of follow up considering the occurrence of arrhythmias.

Abstract 12105: Sudden Death Associated With Pregnancy

Introduction: Sudden and unexpected deaths associated with pregnancy are rare but devastating occurrences in society. There is a significant lack of prospective, population-based data in the US regarding etiologies and clinical manifestation. Hypothesis: Prospective community-wide analyses can inform the assessment of burden as well as prevention strategies for sudden deaths associated with pregnancy. Methods: From the ongoing prospective, Oregon Sudden Unexpected Death Study (ORSUDS, Portland OR catchment pop. 1 M, 2002-2021) and the Prediction of Sudden Death in Multi-Ethnic Communities (PRESTO, Ventura CA catchment pop 850K, 2015-2021), we performed a detailed evaluation of all sudden death cases that occurred within 1 year of pregnancy; including lifetime clinical history, SCA presentation and resuscitation outcome. Results: A total of 381 (46 in PRESTO and 335 in ORSUDS) sudden deaths occurred in females aged 15 to 49 years, and 17 of these (4.5%) occurred within a year of pregnancy. Pregnancy-related cases were between 21 and 39 years of age and included 7 non-Hispanic whites, 5 Hispanic/Latinos, 1 black, 1 Native American and 3 subjects of unknown race/ethnicity. Sudden cardiac arrest occurred while pregnant (6), during delivery (2), within 3 months post-partum (5) and a miscarriage (1), and between 3 and 9 months post-delivery (3). Only witnessed cases survived (4/17, 24%) and presented with both shockable rhythm (2) and non-shockable rhythm (2). Presumptive cause of death included 10 cardiac etiologies including presumed sudden arrhythmic death (4), coronary artery disease (2), left ventricular hypertrophy (1), severe mitral valve prolapse (1), myocardial fibrosis (1) and long QT syndrome (1). Non cardiac causes included drug overdose (2), obstetric thrombo-embolism (2), cerebro-vascular accident (2), and status asthmaticus (1). Conclusions: Our findings suggest that pre-existing heart disease is likely to be the most important risk factor for sudden unexpected death associated with pregnancy, and warrants further detailed investigation.

Фізіологія обміну магнію і застосування магнезії в інтенсивній терапії (літературний огляд із результатами власних спостережень, частина 3)

Ми надали в цьому огляді результати експериментальних і клінічних досліджень, які найбільш переконливо демонструють місце порушень обміну магнію в розвитку пошкоджень міокарда, фатальних аритмій і артеріальної гіпертензії. Ми також висвітлили питання діагностики прихованого дефіциту магнію в організмі і роль дефіциту магнію в патогенезі кардіоміопатії, застійної серцевої недостатності і пролапсу мітрального клапана. Пероральні добавки Mg сприяють зниженню середнього артеріального тиску, периферичного опору судин і частоти ізольованих і залпових шлуночкових екстрасистол і нападів нестійкої шлуночкової тахіаритмії. Вчені виявили, що в багатьох пацієнтів із сильно вираженим пролапсом мітрального клапана рівень Mg в сироватці крові був низьким і прийом добавок з Mg призводить до поліпшення стану пацієнтів. Контроль статусу магнієвого обміну в організмі не тільки необхідний в умовах інтенсивної терапії та стаціонару в цілому, але також актуальний в амбулаторній практиці. Регулярний прийом препаратів Mg або харчових добавок, що містять в основному Mg, може істотно поліпшити результати лікування численних захворювань і запобігти розвитку небезпечних для організму ускладнень. При цьому собівартість магнезіальної терапії є досить низькою.

Mitral and tricuspid annulus disjunction frequently coexist

Abstract Background Mitral annulus disjunction (MAD) is an abnormal atrial displacement of the mitral annulus, frequently found in patients with high-risk arrhythmogenic mitral valve prolapse syndrome. It is unknown whether the annulus disjunction extends to the right side of the heart as tricuspid annulus disjunction (TAD), and whether it is associated with right ventricular electrical instability. Purpose We aimed to explore the presence of TAD, and if extended annulus disjunction was associated with ventricular arrhythmias. Methods We included patients with previously described MAD assessed by cardiac magnetic resonance imaging (CMR) in an ambispective cohort study. MAD and TAD was defined as ≥1 mm separation between the respective atrial wall-valve leaflet junction and the top of the ventricular myocardium. TAD was assessed in the lateral and inferior right ventricular free wall by means of the 4-chamber and right ventricular 2-chamber views, respectively. MAD circumference was assessed by a CMR study protocol with six left ventricular long axis views separated by 30 degrees. Mitral valve prolapse was defined as ≥2 mm superior displacement of any part of the mitral leaflets beyond the mitral annulus. Ventricular arrhythmias were defined as aborted cardiac arrest or non-sustained/sustained ventricular tachycardias recorded by electrocardiogram (ECG), stress ECG or Holter monitoring. Results We included 92 patients with MAD (62% female, age 47±16 years, 71% mitral valve prolapse). TAD was found in 48 (52%) patients, both in the lateral (n=40, 83%) and inferior (n=30, 63%) right ventricular free wall. Patients with TAD were older (age 51±16 years vs. 43±14 years, p=0.01), had greater MAD circumference (168±56° vs. 117±62°, p=0.001) and greater MAD distance (9.2±2.9 mm vs. 6.4±2.8 mm, p<0.001). Additionally, patients with TAD had more frequently mitral valve prolapse (40 patients [85%] vs. 25 patients [57%], p=0.003), whereas similar frequency of bileaflet prolapse (17 patients [39%] vs. 10 patients [39%], p=0.99). Ventricular arrhythmias had occurred in 38 (41%) patients, who were younger (age 40±14 years vs. 52±15 years, p<0.001) and had less frequently TAD (14 patients [37%] vs. 34 patients [63%], p=0.01; univariate odds ratio 0.34 [0.15–0.81], p=0.02). However, TAD was not associated with ventricular arrhythmias when adjusted for age (multivariate odds ratio 0.46 [0.18–1.15], p=0.10). Conclusions TAD by CMR was highly prevalent in patients with MAD and was a marker of severe annulus disjunction and mitral valve prolapse. TAD was not associated with more ventricular arrhythmias. This novel marker warrants further research to explore the clinical implications of right-sided annulus disjunction. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Norwegian Research Council

Tricuspid Annulus Disjunction: Novel Findings by Cardiac Magnetic Resonance in Patients With Mitral Annulus Disjunction

ObjectivesThis study aimed to assess whether patients with MAD also have disjunction of the tricuspid annulus. BackgroundMitral annulus disjunction (MAD) is an abnormal atrial displacement of the mitral annulus. Whether the disjunction extends to the right side of the heart is not known. MethodsIn a cohort of patients with MAD, we assessed the presence of tricuspid annulus disjunction (TAD) with the use of cardiac magnetic resonance. We explored the associations between TAD and MAD characteristics and the relationship to ventricular arrhythmias (nonsustained/sustained ventricular tachycardias and aborted cardiac arrest). ResultsWe included 84 patients (mean age: 48 ± 16 years; 63% female). We observed TAD in 42 (50%). Patients with TAD were older (age 52 ± 16 years vs. 43 ± 15 years; p = 0.02), had greater circumferential extent of MAD (164 ± 57° vs. 115 ± 58°; p = 0.002), greater maximum longitudinal MAD distance (9.4 ± 2.9 mm vs. 6.2 ± 2.8 mm; p < 0.001), and more frequent mitral valve prolapse (n = 39 [92%] vs. n = 24 [57%]; p < 0.001). Ventricular arrhythmias had occurred in 34 patients (41%), who were younger (age 39 ± 14 years vs. 54 ± 14 years; p < 0.001) and had lower prevalence of TAD (n = 22 [29%] vs. n = 12 [52%]; p = 0.03). TAD was not associated with ventricular arrhythmias when adjusted for age (odds ratio adjusted for age: 0.54; 95% confidence interval: 0.20 to 1.45; p = 0.22). ConclusionsWe report for the first time the existence of right-sided annulus disjunction as a common finding in patients with MAD. TAD was associated with more severe left-sided annulus disjunction and mitral valve prolapse, but not with ventricular arrhythmias.

Mitral annular disjunction in patients with primary severe mitral regurgitation and mitral valve prolapse.

Mitral annular disjunction is a structural abnormality of the mitral annulus fibrosus which is often associated with mitral leaflet prolapse. However, few reports have described mitral annular disjunction in mitral valve prolapse (MVP). This study aimed to investigate the characteristics of mitral annular disjunction in patients with severe mitral regurgitation (MR) caused by MVP. We reviewed 185 consecutive patients with severe MR caused by fibroelastic deficiency (FED) and Barlow's syndrome from March 2009 to December 2010. The upper limit of the disjunction was defined at the level of the posterior scallop's insertion into the left atrial wall, whereas the lower limit was defined at the level of the left atrium's connection to the ventricular myocardium. The distance between the two levels was called mitral annular disjunction. Prolapse sites in FED patients were categorized into anterior leaflet, posterior leaflet, and commissure groups. Patients with a disjunction distance of ≥2mm were diagnosed with mitral annular disjunction. Annular disjunction was found in 45 patients (24%). Among them, the most common site of prolapse was the posterior leaflet (n=35, 77.8%). During a median follow-up of 20.3years, arrhythmic events and sudden death occurred in seven patients (3.8%). Mitral annular disjunction was detected in 24% of patients with severe MR and in 90% of the patients with Barlow's syndrome. There were significant differences at its sites of prolapse in FED patients. The presence and site of prolapse with mitral annular disjunction should be actively determined in FED patients.

Impact of Thermotherapy on Severe Mitral Valve Prolapse: An Approach from Persian Medicine

This article is a Letter to Editor and does not include an Abstract.

Invited Commentary

In this issue of The Annals of Thoracic Surgery, Anwer and colleagues [1Anwer L.A. Dearani J.A. Daly R.C. et al.Degenerative mitral regurgitation after nonmitral cardiac surgery: MitraClip versus surgical reconstruction.Ann Thorac Surg. 2019; 107: 725-732Abstract Full Text Full Text PDF Scopus (9) Google Scholar] from the Mayo Clinic present their experience of treating degenerative mitral valve disease in patients who have had prior cardiac surgery for non-mitral disease. They compared conventional surgical techniques with MitraClip in a cohort of patients with degenerative disease with severe mitral regurgitation (MR). The 30-day mortality remained 2.7% versus 3.6% for the surgical and MitraClip arms, respectively. What was striking was the incidence of residual MR (more than moderate) in MitraClip patients (43.1%) compared with 5.4% in the surgical arm at the time of discharge. The residual MR remained in 66.7% of the MitraClip patients compared with 33.3% of the patients in the surgical arm at 1-year follow-up. A quarter of the patients in the MitraClip arm did not survive to 1 year (23.2%), whereas 17.3% died in the surgical arm. I congratulate the Mayo team for presenting this crucial information to the readers, because it may have significant implications as to how we view options for therapy in degenerative mitral valve disease in patients who may have had prior cardiac surgery. The surgical principles for addressing MR is distinct in surgery with predominately anatomic repair being the basis with reduction of annular diameter, resection of excess leaflet prolapse by leaflet plasty techniques, and in rarity (8% in the present cohort) of an edge-to-edge repair. In contrast, MitraClip relies solely on edge-to-edge approximation to reduce the severity of MR. Setting aside a surgical bias, one would assume that the rate of success in reducing MR by an edge-to-edge repair by MitraClip in degenerative MR should be fairly high; however, this did not prove to be a fact in the present study. The operators were experienced and the current MitraClip population formed a third of their total experience with this device. Of note, the health status as determined by the 12-item Kansas City Cardiomyopathy Questionnaire remained fairly high among the surgical arm. However, a mortality of 17.3% in surgical patients at 1 year makes a sobering read. The article asks the simple yet complicated question as to what should we propose to our patients presenting with degenerative MR after prior cardiac surgical intervention. Solely looking at the present study the balance is in favor of surgical therapy albeit with higher mortality than comparable cardiac surgical procedures at 1 year but with superior health status and lower re-intervention rate. Catheter-based cardiac surgical interventions are fast approaching clinical practice, and novel solutions such as a MitraClip (which is based on surgical procedure of edge-to-edge repair) are likely to strengthen the armament of physicians involved with treating this disease which has a poor prognosis with medical therapy alone. All our current strategies (surgical and catheter based) are heavily aimed at correction of valvular regurgitation by obtaining a competent valve. However, one may argue that we may need to have a fresh look at the left ventricular shape dynamics vis a vis MR, which is likely to give impetus in improving our surgical techniques and innovating novel catheter-based solutions that can alter subvalvular apparatus to give more robust results in patients with both degenerative and functional MR. Degenerative Mitral Regurgitation After Nonmitral Cardiac Surgery: MitraClip Versus Surgical ReconstructionThe Annals of Thoracic SurgeryVol. 107Issue 3PreviewSurgical mitral valve repair is the conventional treatment for severe degenerative mitral regurgitation (MR). MitraClip therapy has emerged as a viable option in high-risk surgical patients. We sought to compare conventional surgery to MitraClip therapy in patients with severe degenerative mitral valve prolapse (MVP) and previous cardiac interventions. Full-Text PDF

Degenerative Mitral Regurgitation After Nonmitral Cardiac Surgery: MitraClip Versus Surgical Reconstruction

Surgical mitral valve repair is the conventional treatment for severe degenerative mitral regurgitation (MR). MitraClip therapy has emerged as a viable option in high-risk surgical patients. We sought to compare conventional surgery to MitraClip therapy in patients with severe degenerative mitral valve prolapse (MVP) and previous cardiac interventions. From January 2012 to May 2016, 131 patients with previous cardiac surgery and subsequent intervention for degenerative MVP were included in this analysis: 75 (57.3%) underwent surgical repair and 56 (42.7%) underwent MitraClip placement. Follow-up was available in all early survivors at median of 11 (interquartile range, 0 to 32) months for surgery and 11 (interquartile range, 3 to 21) months for MitraClip patients. MitraClip patients were older (75.7 ± 8.6 years of age versus 68.6 ± 13.1 of age; p < 0.001), and had higher Society of Thoracic Surgeons risk scores (5.8 ± 2.4 versus 2.7 ± 2.3; p < 0.001). Median length-of-stay was 7 (interquartile range, 5 to 11) days for surgery and 2 (interquartile range, 2 to 4) days for MitraClip patients (p < 0.001), but 30-day mortality was comparable between the 2 groups (2.7% versus 3.6%; p= 0.77). Recurrent MR (moderate or severe) was significantly higher for MitraClip patients, both at discharge (43.1% versus 5.4%; p < 0.001) and at 1-year follow-up (66.7% versus 33.3%; p= 0.02). At 1 year postintervention, freedom from mitral reintervention was significantly higher for surgical patients (100.0% versus 87.5%; p=0.006). In patients with previous cardiac interventions and severe degenerative MVP, a repeat conventional surgery is safe and durable. Percutaneous MitraClip repair is effective but associated with higher risk of residual MR, and should only be considered in selected patients. Careful patient selection using a heart team approach is recommended.

Mitral valve prolapse and aortic root dilation in adults with hypermobile Ehlers-Danlos syndrome and related disorders.

Ehlers-Danlos syndromes (EDSs) are a group of inherited connective tissue disorders, and among them, classical EDS (cEDS) and hypermobile EDS (hEDS) are the most common. Mitral valve prolapse (MVP) and aortic root dilation (ARD) have previously been reported to occur at an increased frequency within cEDS and hEDS. More recently, a study performed in the pediatric population did not show increased prevalence (Ritter et al., American Journal of Medical Genetics Part A, 173(6), 1467-1472, 2017). The purpose of this study was to review a large population of individuals with cEDS, hEDS, and hypermobility spectrum disorders to determine the frequency of MVP and ARD. A retrospective chart review of 209 individuals with echocardiograms was performed. Overall, 6.4% (13/209) had MVP and 1.6% (3/189) were found to have ARD. Although the presence of MVP is higher than what has been reported in the general population, no patients had severe MVP or required surgical intervention. No patients in this cohort had an aortic root diameter requiring surgical repair. Based on the results of this study and previous studies, routine echocardiograms to assess for valvular diseases and ARD may not be necessary unless warranted by presence of symptoms or family history.

Cardiorespiratory complications in patients with osteogenesis imperfecta

Osteogenesis imperfecta (OI) is a hereditary connective tissue disorder, usually caused by dominant mutations of genes coding forcollagen type I alpha chains, COL1A1/A2. Although skeletal manifestations of OI are most readily observable, cardiopulmonarydisorders in patients with OI are increasingly recognized as life-threatening but treatable disorders. Unfortunately, the majority ofpatients with moderate to severe types of OI die from or with cardiopulmonary complications. The lungs and the heart are oftenunrecognizable and neglected organs in patients with OI. In monitoring of patients with OI, attention is mostly focused on monitoringlong bone and spine deformities, and indirectly deformities of the chest wall, which have consequences on the development oflung and the airway diseases. Lung disorder is frequently ignored until breathing problems become severe. An important componentin patients with OI is obstructive lung disease, sleep disordered breathing, as well as acute and chronic infection often connectedwith resultant bronchiectasis. In addition to respiratory complications, some patients with OI have serious cardiovascularproblems, including severe mitral valve prolapse, aortic valve insuffi ciency and dilation of the aorta, which require cardiac surgery.The diagnosis and management of the lung and cardiovascular complications in some patients with OI are quite diffi cult. In allpatients with OI, it is important to recognize and monitor respiratory and cardiovascular manifestations in order to prevent furtherprogression of any complications.Key words: osteogenesis imperfecta; pulmonary disease; pulmonary function; lung infections; cardiovascular manifestation; prevention

Mitral Valve Prolapse Classification from an Echocardiography Sequence using Coherent Point Drift Method based on Fractal Dimension

Background: Mitral Valve Prolapse (MVP) is now recognized as the most common cardiovalvular abnormality (CVA) in the USA, but there has been much less agreement about other aspects of its epidemiology, diagnosis and clinical features. CVA analysis still relies mainly on the visual assessment of echocardiographic imaging and manual measurements by experienced cardiologists. So, automating or semi-automating analysis of echocardiographic images for MVP detection is, therefore, highly desirable, but also challenging due to low image quality and high amount of speckle noise. Objective: The main objective of this paper was to test the hypothesis that fractal dimension (FD) values are significantly higher in severe MVP and moderate MVP cases than those of healthy subjects in motion pattern of their mitral valves. Materials and Methods: In this paper, we present a noninvasive algorithm that does not require any segmentation. This approach has three steps: first, we extracted corners as landmarks from echocardiographic sequences based on SUSAN corner detector. Then, landmarks were tracked using Coherent Point Drift (CPD) non-rigid registration. After that, the motion patterns of the landmarks were analyzed to extract features (FD) in order to classify the mitral valve behavior of 46 patients and 25 normals as normal, moderate or severe MVP. Results: The results show that moderate MVP detection has a relatively good sensitivity (82%) and specificity (82%). Conclusion: The motion pattern of landmarks in MVP patients, obtained by CPD method, differed from that of normals in such a way that the difference can be quantified and analyzed by FD.

Acute onset heart failure due to Marfan syndrome

A 28-year-old visiting from Central America presented with twenty-four hours of lower extremity swelling, dyspnea and orthopnea. Clinically, she was diagnosed with acute heart failure requiring inotropes with a transthoracic echocardiogram revealing severe mitral regurgitation with a normal ejection fraction. Subsequent transesophageal echocardiogram confirmed severe mitral regurgitation with aortic root dilatation (Z-score: 3.9). She was also found to have arachnodactyly, scoliosis on X-ray and severe mitral valve prolapse. Given her clinical features she was assessed for Marfan syndrome with the modified Ghent nosology systemic score and met diagnostic criteria. A FBN1 genetic test confirmed the diagnosis of Marfan syndrome discovering a frameshift mutation resulting in an inappropriate stop codon and peptide truncation. For patients presenting with heart failure at an atypical age without typical risk factors, rare conditions such as Marfan syndrome should be considered. Marfan syndrome can accurately and quickly be screened for and diagnosed using the systemic score from the modified Ghent nosology.

Mitral valve cleft associated with secundum atrial septal defect: case report and review of the literature

Mitral valve cleft associated with secundum atrial septal defect (ASD) is uncommon. We report a 39-year-old male patient manifesting symptoms of congestive heart failure 3 months before admission. Echocardiography showed typical mitral valve prolapse and a large ASD of the secundum type. He was diagnosed as severe mitral regurgitation and ASD. At operation, severe mitral valve prolapse with additional degenerative leaflets and a middle-sized cleft in the anterior leaflet were noted. A large ASD of a mixed central and inferior vena cava type was found. Mitral valve repair was impossible. The mitral valve was replaced with an ATS prosthesis. The ASD was repaired with a pericardial patch. Three slow arrhythmias, including nodal rhythm, sinus bradycardia and atrial fibrillation, complicated his early postoperative course. The literature of this entity was reviewed, and the etiology of the postoperative slow arrhythmias was discussed.

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.

An unusual finding of left ventriculography in Marfan syndrome with severe mitral valve prolapse

A 16-year-old boy with Marfan syndrome was scheduled for open-heart surgery for dilated aortic sinuses of Valsalva. Preoperative cardiac catheterization with left ventricular angiography demonstrated bulging at the junction of the mitral annulus with an appearance like ‘a swim ring’. Transthoracic echocardiography showed severe mitral prolapse with the mitral valve leaflets rising toward the left atrium and stretching of the chordae tendineae. ECG-gated contrast CT revealed that this bulging was not the left ventricle itself but the interspace between the base of the left ventricle and mitral valve leaflets. This bulging disappeared after mitral valve plasty with an annuloplasty ring. This unusual finding might herald chordae tendinae rupture in Marfan syndrome.

Exercise-induced Acute Mitral Valve Chordae Rupture

Exercise is a rare cause of acute chordae rupture, which is one of the important and emergent differential diagnoses in approaching a patient presenting with dyspnea. Several common diseases such as rheumatic heart disease and infectious diseases have been known to cause chordae rupture. Severe mitral valve prolapse had been reported to be at increased risk for chordal rupture. Because mitral valve prolapse may present in up to 10% of healthy individuals, primary care practitioners should recognize that certain patients with mitral valve prolapse who engage in athletics may be at increased risk for such a rare but emergent complication.

A Novel Method of Leaflet Reconstruction After Triangular Resection for Posterior Mitral Valve Prolapse

Triangular leaflet resection to treat posterior mitral valve prolapse is expedient, sufficient, and durable in eliminating redundant myxomatous tissue and restoring normal leaflet coaptation. After triangular resection and suture reconstruction, mitral scallop height is decreased to a degree commensurate with the area of tissue resected. There are instances however, when excessive bulk of the remaining posterior leaflet may persist, predisposing to systolic anterior motion of the anterior mitral leaflet. We propose a novel adjunctive measure to normalize posterior leaflet height during suture reconstruction by ventricularizing what would otherwise have become the new tip of the posterior mitral leaflet. We have found that ventricularization of the leaflet edge during reconstruction obviates the need for excessive mitral leaflet resection, resulting in a symmetric and mobile neo-free edge that are capable of contributing to a robust zone of coaptation.