Severe Mitral Valve Prolapse Research Articles

Two-dimensional echocardiographic mitral valve prolapse: Evidence for a relationship of echocardiographic morphology to clinical findings and to mitral annular size

Fifty adult patients with two-dimensional echocardlograms (2DE) meeting standard diagnostic criteria for mitral valve prolapse (MVP) were studied to evaluate the significance of a positive 2DE by using a new morphologic grading system, a simplified method for annular measurement, and clinical data. Patients with mild (grade I) 2DE MVP differed significantly from those with moderate (grade II) to severe (grade III) 2DE MVP. Mild prolapse patients were predominantly female ( p = 0.05) and younger ( p < 0.01). Atypical physical findings were associated with mild MVP while mitral insufficiency murmurs were associated with moderate to severe MVP ( p < 0.0025). When present, atypical chest pain and/or low-grade ventricular ectopy were associated with mild 2DE MVP, while pulmonary congestion, high-grade ectopy, and/or endocarditis were associated with moderate to severe 2DE MVP ( p < 0.001). Symptomatic moderate to severe 2DE MVP patients tended to have large annular dimensions. Additional echocardiographic characteristics of mild 2DE MVP included insensitivity of the parasternal long-axis 2DE view in its detection ( p = 0.00002), predominance of anterior leaflet involvement in the apical 2DE view ( p = 0.01), and absence of significant difference from age- and sex-matched control subjects in any annular dimension. In contrast, moderate to severe 2DE MVP showed highly significant differences from age- and sex-matched control subjects and from each other in all annular dimensions. Echocardiographically mild MVP defines a subgroup which differs quantitatively and clinically from more advanced morphologic variants. The use of mild 2DE MVP as a diagnostic criterion for MVP should be qualified as being “of questionable diagnostic significance.” When present, with or without corroborative auscultatory findings, it may define a subgroup of prolapse at lower risk of significant clinical events or one that represents a normal echocardiographic variant. New grading and annular measurement methodologies provide additional tools for 2DE analysis of MVP with potentially important clinical and prognostic implications.

Study on the mitral valve prolapse. I. Incidence in Kobe University students. II. Follow up study.

Incidence of mitral valve prolapse (MVP) in 4517 students of Kobe University, and clinical features in cases with MVP were studied. MVP was detected in 42 cases by two-dimensional echocardiography, and the prevalence of MVP was 0.93 percent (42 of 4517 cases). Among 42 cases with MVP, apparent mitral regurgitation (MR) was noted in one case with severe MVP, ventricular tachycardia was detected in one and ST-T wave abnormalities were detected in 10 respectively. In another follow up study of our hospital, 14 of 85 patients followed more than one year were noted to be deterioration in echocardiographic parameters. Eight of 14 patients had severe prolapse with severe MR, but remaining 6 had mild or moderate prolapse with mild or absent of MR. However, ST-T wave abnormalities, serious arrhythmias, and low response of %FS increase on exercise were found in high incidence in 6 of mild or moderate prolapse as well as in severe prolapse. So these follow up results suggested that not only students with severe MVP but also students with mild or moderate MVP with ST-T wave changes or VPC found in university medical examination must be followed up carefully.

Surgical correction of severe mitral prolapse without mitral insufficiency but with pronounced cardiac arrhythmias

Despite what was considered adequate pharmacological treatment, the condition of six patients with severe mitral valve prolapse but with trivial or no mitral regurgitation deteriorated. These patients had marked weakness, chest pain, dyspnea, and arrhythmias. Because these patients found their condition to be intolerable, the prolapsed mitral valve was repaired. Electrocardiography, treadmill stress testing, and left ventirculography performed following operation showed complete repair of the valve and significant improvement over the preoperative findings in all six patients. Repair of the floppy mitral valve did not eradicate all abnormalities; however, it did significantly improve the chest pain, weakness, dyspnea, and arrhythmias in all six patients. Five patients no longer require any medication. The prolapsed mitral valve contributed significantly to the symptoms and arrhythmias, but it could not have been the sole cause for these patients' signs and symptoms. With complete correction of the prolapse in all six patients, few of the signs and symptoms of the disease persisted. Repair of severe mitral valve prolapse without mitral regurgitation is recommended only for those patients who continue to be severely symptomatic from chest pain, dyspnea, or ventricular arrhythmias after an extensive trial of adequate medical therapy.

Insensitivity of echocardiography in detecting mitral valve prolapse in older patients with chest pain

Although echocardiography has proved useful in detecting mitral valve prolapse, its limitations have not yet been adequately defined. This study was designed to evaluate the prevalence of false negative echocardiograms in patients with angiographically proved mitral valve prolapse. Twelve patients, eight men and four women with a mean age of 47 years, were selected on the basis of the results of cardiac catheterization for chest pain. Each patient had moderate to severe mitral valve prolapse, confirmed angiographically by two observers, with no coronary artery disease or other detectable cardiac abnormalities. Clinically, a systolic click was detected in three patients, a mid-systolic murmur in five, an abnormal electrocardiogram in four and a positive maximal treadmill stress test in two of eight tested. Left ventricular angiograms exhibited anterior and posterior leaflet prolapse in five, and posterior leaflet prolapse alone in seven. High quality echocardiograms were obtained in 11 patients; one record of inadequate quality was excluded. The echocardiograms revealed mitral valve prolapse in only one case, and were “probably” negative in two, and clearly negative in eight. Although these results may reflect the well recognized variable clinical expression of this syndrome, they indicate that false negative echocardiograms are common in this selected older population of patients with angiographic mitral valve prolapse who present with chest pain and few other clinical features. Thus, caution must be exercised in the clinical interpretation of a single echocardiogram negative for mitral valve prolapse.