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At least 19 recordsLinked to original sources

PubMed2000

Current management of mitral valve prolapse.

Mitral valve prolapse is a pathologic anatomic and physiologic abnormality of the mitral valve apparatus affecting mitral leaflet motion. "Mitral valve prolapse syndrome" is a term often used to describe a constellation of mitral valve prolapse and associated symptoms or other physical abnormalities such as autonomic dysfunction, palpitations and pectus excavatum. The importance of recognizing that mitral valve prolapse may occur as an isolated disorder or with other coincident findings has led to the use of both terms. Mitral valve prolapse syndrome, which occurs in 3 to 6 percent of Americans, is caused by a systolic billowing of one or both mitral leaflets into the left atrium, with or without mitral regurgitation. It is often discovered during routine cardiac auscultation or when echocardiography is performed for another reason. Most patients with mitral valve prolapse are asymptomatic. Those who have symptoms commonly report chest discomfort, anxiety, fatigue and dyspnea, but whether these are actually due to mitral valve prolapse is not certain. The principal physical finding is a midsystolic click, which frequently is followed by a late systolic murmur. Although echocardiography is the most useful mode for identifying mitral valve prolapse, it is not recommended as a screening tool for mitral valve prolapse in patients who have no systolic click or murmur on careful auscultation. Mitral valve prolapse has a benign prognosis and a complication rate of 2 percent per year. The progression of mitral regurgitation may cause dilation of the left-sided heart chambers. Infective endocarditis is a potential complication. Patients with mitral valve prolapse syndrome who have murmurs and/or thickened redundant leaflets seen on echocardiography should receive antibiotic prophylaxis against endocarditis.

Diagnosis, Differential↗

PubMed1991

Mitral valve prolapse.

Mitral Valve Prolapse (MVP) is a common cardiac disorder in our community. It is estimated that 4% to 15% of the general population have the anatomical defect of prolapsed mitral valve leaflets during ventricular systole. Patients with MVP that suffer from chest pain, dyspnea, fatigue, dizziness, syncope, palpitations, cardiac arrhythmias, anxiety, and panic attacks are diagnosed as having Mitral Valve Prolapse Syndrome. There is much controversy in the medical literature as to the causes of MVPS symptomatology. Some scientists believe that autonomic dysfunction, adrenergic, and vagal responsiveness are factors which appropriately explain the symptoms of MVPS. Pharmacological therapy, depending on the severity of the symptoms, is one option for treatment. Education on the etiology of their symptoms, instruction on lifestyle modifications, and reassurance from their physician are appropriate methods for the management of MVPS patients.

Autonomic Nervous System↗

PubMedDate not supplied

Mitral valve prolapse.

Mitral valve prolapse is a common valvular abnormality that is the most common cause of severe non-ischaemic mitral regurgitation in the USA. The overall prognosis of patients with mitral valve prolapse is excellent, but a small subset will develop serious complications, including infective endocarditis, sudden cardiac death, and severe mitral regurgitation. We present a comprehensive review of mitral valve prolapse, examining normal mitral anatomy, the clinical and echocardiographic features of mitral valve prolapse, and the pathophysiology and genetics of the disorder. We discuss the contemporary management of both asymptomatic and symptomatic prolapse, with particular attention to the timing and technique of surgical repair. We conclude that echocardiography is the method of choice for diagnosing mitral valve prolapse, that clinical and echocardiographic features can predict which patients with prolapse are at highest risk for complications, and that mitral valve repair is the treatment of choice for symptomatic prolapse.

Echocardiography↗

PubMed1987

Mitral valve prolapse.

Mitral valve prolapse is a common mitral valve disorder manifested clinically as a midsystolic click and/or a late systolic murmur (the click-murmur syndrome) and pathologically as billowing or prolapsing mitral leaflets (the floppy valve syndrome). Not only is it one of the two most common congenital heart diseases and the most common valve disorder diagnosed in the United States, but it is also prevalent throughout the world. Mitral valve prolapse may be associated with a variety of other conditions or diseases. Diagnosis of mitral valve prolapse should be made on clinical grounds and, if necessary, supported by echocardiography. The majority of patients with mitral valve prolapse suffer no serious sequelae. However, major complications such as disabling angina-like chest pains, progressive mitral regurgitation, infective endocarditis, thromboembolism, serious arrhythmias, and sudden death may occur. Unless these serious complications occur, most of the patients with mitral valve prolapse need no treatment other than reassurance, including those with atypical chest pain or palpitation unconfirmed by objective data. Therapy with a beta-blocker for disabling chest pain and/or arrhythmias and antiplatelet therapy for cerebral embolic events may be indicated. In occasional patients with significant mitral regurgitation surgery may be necessary.

Echocardiography↗

PubMed1986

Vertical left ventricular angulation assessed by thallium 201 myocardial perfusion imaging in patients with mitral valve prolapse.

Mitral valve prolapse has been associated with septal to aortic root angle abnormalities determined by echocardiography. Thallium 201 imaging in the anterior view permits visualization of the left ventricular long axis. In the present study, the vertical angle was defined as the angle formed by the long axis of the left ventricle and a horizontal line. The vertical angle was determined in 25 patients who had 201 TL stress testing and M-mode echocardiography. Group I (11 patients) had mitral valve prolapse and group II (14 patients) did not have mitral valve prolapse. The vertical angle and ultrasound were read blinded to each other. Height, weight, and body surface area were compared for the two groups, and receiver operator curve analysis performed. Vertical angle measured by TL 201 was significantly more vertical in patients with mitral valve prolapse. Receiver operator curve analysis showed that an angle of greater than 30 degrees successfully identified 9/11 patients with mitral valve prolapse, with a sensitivity of 82% and a specificity of 79%. There were no significant differences in height, weight, or body surface area between the two groups. Thus, patients with mitral valve prolapse have more vertically positioned hearts than patients without mitral valve prolapse, independent of body habitus. The different appearance of a vertically oriented heart may contribute to false-positive readings of TL 201 images.

Adult↗

PubMed2000

[Mitral valve prolapse].

Mitral valve prolapse has previously been found to be associated with severe cardiovascular complications such as embolic insults, infectious endocarditis, and sudden cardiac death. However, at the same time, in particular after adopting M-mode and 2D echo for diagnosis, prevalence of the disease was found to be very high, especially in the young. The dilemma of a disease which is frequent and mostly asymptomatic, but in some cases has catastrophic complications, has been solved by implementation of more restrictive diagnostic criteria based on an appreciation of the spatial morphology of the mitral annulus. These criteria call for diagnosis exclusively based on long axis views and a prolapse of > 2 mm beyond a line connecting the leaflet insertion points. "Classic prolapse" additionally requires diastolic thickness of the mitral leaflets of at least 5 mm. Two recent studies, a population-based study of mitral valve prolapse prevalence, and a case-control study of juvenile stroke patients compared to a group of young patients without a history of stroke, shed further light on this disease. The authors found that prevalence of mitral valve prolapse in an average population is 2-3% (1.3% for classic prolapse), without age or sex preponderance; the rate of cerebrovascular insults, congestive heart failure, and atrial fibrillation of patients with prolapse does not exceed that of the rest of the population; however, mitral insufficiency is more frequent; young patients with a history of cerebrovascular insult do not have higher mitral valve prolapse rates than young patients without previous insult.

Cross-Sectional Studies↗

PubMed1984

Mitral valve prolapse.

Mitral valve prolapse is a very common condition. It occurs in 4-5% of the population. It may be idiopathic or associated with a number of other conditions. Myxomatous degeneration is the underlying mechanism of mitral valve prolapse. Most patients with mitral valve prolapse have no symptoms. When symptoms do occur, palpitations, chest pain and dyspnea are the major complaints. The midsystolic click occasionally followed by the late systolic murmur are the typical physical findings. The echocardiogram plays a big role in the diagnosis of mitral valve prolapse. The beta blockers are used in the treatment of the symptomatic patient.

Adrenergic beta-Antagonists↗

PubMed1985

Chronic thyroiditis and mitral valve prolapse.

Mitral valve prolapse is more prevalent in patients with autoimmune diffuse toxic goiter, suggesting a possible etiologic association. The prevalence of mitral valve prolapse was determined in 75 patients with chronic lymphocytic thyroiditis, another autoimmune thyroid disorder, and in 50 healthy control subjects. Mitral valve prolapse was found in 31 of 75 (41%) patients with chronic lymphocytic thyroiditis and in 4 of 50 (8%) controls (odds ratio, 8.10; 95% confidence interval, 2.64 to 24.83; p less than 0.0005). The age-race adjusted odds ratio was 9.26 (95% confidence interval, 2.83 to 30.26; p less than 0.0005). No correlation between the prevalence of mitral valve prolapse and the presence of hypothyroidism, serum antithyroid antibodies, or the duration of chronic lymphocytic thyroiditis was found. The prevalence of mitral valve prolapse is substantially increased in patients with the autoimmune thyroid disorders.

Adult↗

PubMed1996

[Anesthesia for cesarean section in patients with mitral valve prolapse].

Mitral valve prolapse is the most frequent cardiac valvulopathy. Given its greater incidence in young women it is a factor which must be taken into account when performing cesarean section. Two patients with mitral valve prolapse in whom a cesarean section was carried out are presented: case 1, a 22-year-old woman, ASA II, 72 kg, with mitral valve prolapse associated with the Wolf-Parkinson-White syndrome and an episode of paroxysmal supraventricular tachycardia. The cesarean section which was indicated because of the absence of fetal progression was performed under epidural anesthesia. Forty-five minutes after regional blockade a hypotensive episode was observed which remitted following the i.v. administration of 6 mg of methoxamine. No other complication was reported. The Apgar score of the neonate at one minute was 7; case 2, a 31 year-old woman, ASA II, 51 kg, diagnosed with mitral valve prolapse with no associated symptomatology. A cesarean section was performed in this patient because of pedal presentation under general anesthesia without complications. The Apgar score of the neonate at one minute was 8. The physiopathology of mitral valve prolapse as well as anesthesia management during cesarean section in this type of valvulopathy is reviewed.

Adult↗

PubMed2006

Ventricular fibrillation due to severe mitral valve prolapse.

Mitral valve prolapse usually has a good prognosis. However, an association between mitral valve prolapse and atrial and ventricular arrhythmias has been described. This case presents a patient who was admitted after cardiac resuscitation due to ventricular fibrillation. A severe mitral valve prolapse was the only pathology found.

Cardiopulmonary Resuscitation↗

PubMed1976

Mitral valve prolapse.

Mitral valve prolapse is a condition that is being recognized with increased frequency. It is not known whether its incidence is increasing, or whether we are better able to diagnose it today. In the idiopathic or familial variety, the mitral valve pathology is almost always that of myxomatous degeneration. Some authors have suggested the presence of a cardiomyopathy because of significant left ventricular dysfunction in many cases. Idiopathic prolapse occurs predominantly in females, often at a young age, and may be associated with chest pain, dyspnea, fatigue, presyncope, syncope, and/or sudden death. The clinical findings are variable and typically consist of a nonejection click and/or late systolic murmur, heard best at the cardiac apex. Diagnosis can be confirmed by echocardiography and/or ventricular cineangiography, the latter permitting accurate recognition of the anatomy of the prolapsed leaflets. The complications of infective endocarditis, severe mitral insufficiency, and life-threatening ventricular arrhythmias represent the major problems of management. It is important to distinguish the idiopathic form of mitral valve prolapse from that due to coronary artery disease and to realize that mitral valve prolapse may occur in Marfan's syndrome, Turner's syndrome, or in association with secundum atrial septal defect or ruptured chordae tendineae. Typical clicks and/or murmurs have also been described in patients with a history of rheumatic fever and in hypertrophic cardiomyopathy. Although much descriptive knowledge has accumulated over the past 15 years, many unanswered questions remain regarding the idiopathic type of prolapse. What is the nature and cause(s) of myxomatous degeneration? What is the relation of the valve pathology to the left ventricular dysfunction? What is the relation of both of these factors to disabling chest pain, electrocardiographic changes, and life-threatening arrhythmias? Hopefully, answers to these and other important questions regarding mitral valve prolapse will be forthcoming.

Electrocardiography↗

PubMed1985

[Complications of mitral valve prolapse].

Mitral valve prolapse, usually a benign condition, is aggravated in 15% of the cases by one or the other of five different complications. Mitral regurgitation may develop progressively or abruptly following rupture of the chordae tendinae and requiring prompt surgical repair. Bacterial endocarditis has been observed in 2.9% of the cases, hence the need for preventive antibiotic therapy prior to dental treatments or surgical operations in patients with holosystolic or end-systolic mitral murmur. Among arrhythmias, only ventricular extrasystoles (which are frequent and most often occur in pairs or salvos or are polymorphous) tachycardia and ventricular fibrillation may be considered as true complications of mitral valve prolapse and should be treated initially with beta-blockers. Sudden death is the major complication encountered in 1.4 to 2.4% of the patients; particularly exposed are women around 40 years of age who previously experienced syncopes or episodes of faintness due to attacks of tachycardia or ventricular fibrillation. Ophthalmic or cerebral ischaemic accidents occur with an incidence of 3.5%; some 20 to 30% of subjects under 45 who suffer from these accidents present with mitral valve prolapse.

Arrhythmias, Cardiac↗

PubMed1997

Accuracy and cost-effectiveness of exercise echocardiography for detection of coronary artery disease in patients with mitral valve prolapse.

Mitral valve prolapse is sometimes associated with chest pain, but this symptom may also be caused by coexisting coronary disease. The accuracy of exercise echocardiography in diagnosing coronary disease in these patients and the most cost-efficient diagnostic approach are unclear. We studied 96 patients (aged 59 +/- 12 years; 70 men) with mitral valve prolapse who underwent exercise electrocardiography, exercise echocardiography, and coronary angiography. The accuracies of seven diagnostic strategies based on the current and expected use of exercise electrocardiography and exercise echocardiography in patients with mitral valve prolapse were examined, with the costs calculated based on Medicare reimbursement. Thirteen (13.5%) patients had significant coronary artery disease. The sensitivity and specificity of exercise electrocardiography in the 71 patients with interpretable electrocardiograms were 50% and 72%, respectively. For the 73 patients who achieved >85% of maximal heart rate, 52 had interpretable exercise electrocardiograms (sensitivity 50%; specificity 69%). Exercise echocardiography had a sensitivity of 69% and a specificity of 98% in the 96 patients and a sensitivity of 82% and a specificity of 96% in patients who achieved >85% of maximal heart rate. Approaches adopting Bayes' theorem and restricting further investigation to patients with at least intermediate pretest probability of coronary disease were the least costly. When combined with exercise echocardiography as the initial test, clinical stratification was associated with a false-negative rate of 21%. The utility of exercise electrocardiography is limited by the high prevalence of resting electrocardiographic abnormalities and suboptimal sensitivity and specificity. The best balance of cost and diagnostic accuracy is to perform exercise echocardiography in patients with at least intermediate probability of coronary artery disease.

Aged↗

PubMed1982

[Vectorcardiographic analysis of atrial activation in isolated mitral valve prolapse. Atrial vectorcardiography in prolapsed mitral valve].

The purpose of our work is to study atrial depolarization in primary mitral prolapse (MVP), since, as far as we know, such a study has never been performed. Thirty patients with MVP were studied: 23 females, aged 37,3 +/- 15,5 years and 7 males, aged 45.1 +/- 18.1 years. MVP was diagnosed by M-mode echocardiography. Atrial depolarization was analysed on photographically recorded Frank's vectorcardiograms. On PsE loops, magnitude and direction of maximum planar vector (VMax) in the frontal (F) and left sagittal (LS) planes, magnitude and direction of anterior (HV1) and posterior (HV2) vectors in the horizontal (H) plane, HV1 to HV2 amplitude ratio and total atrial activation time (T) were measured. This last value (T), measured on vectorcardiographic records, was confirmed by high-speed (200 mm/sec) electrocardiograms. These data were compared, by mean of Student's test, with those measured on records obtained from a similar group of normals. The following statistically significant (P less than 0.05) differences were detected: decreased amplitude of VMax in F (0.11 +/- 0.03 vs. 0.080 +/- 0.03) and LS (0.11 +/- 0.03 vs. 0.085 +/- 0.03), backward shift of HV2 (+65 degrees +/- 39 degrees vs. + 11 degrees +/- 35 degrees) and decreased T (98 +/- 25 vs. 85 +/- 17). The decrease of total atrial activation time, about 13% less than in normals, is the most interesting finding of our research. Such an alteration of atrial depolarization can be explained by inter- and/or intra-atrial conduction disturbance, on anatomical or functional base. Therefore, our findings are consistent either with the hypothesis that MVP is secondary to widespread pathological changes or with the one that MVP is a consequence of neurovegetative imbalance.

Adolescent↗

PubMed1989

Mitral valve prolapse.

Mitral valve prolapse continues to arouse considerable interest because of its worldwide prevalence, lack of unanimity in diagnostic criteria, and association with such potentially serious complications as angina-like chest pain, cardiac arrhythmias, sudden death, progressive mitral regurgitation, cerebral embolism, and infective endocarditis. This review includes a discussion of the prevalence of mitral valve prolapse around the world, a critical review of the diagnostic criteria, and a discussion of the pathophysiology of the important complications, with special emphasis on cardiac arrhythmias.

Humans↗

PubMed1986

Childhood mitral valve prolapse.

Mitral valve prolapse is now the most common cardiac diagnosis of childhood. The auscultatory findings of a non-ejection click with or without an associated murmur of mitral insufficiency are reviewed and related to the pathologic and histologic abnormalities. Findings at presentation in a large series of patients are given. Potential problems with progressive mitral insufficiency, arrhythmias and bacterial endocarditis are reviewed. This overview attempts to establish the essentially benign nature of mitral valve prolapse in childhood while indicating areas where continued observation is necessary.

Arrhythmias, Cardiac↗

PubMed1985

Mitral valve prolapse.

Mitral valve prolapse, diagnosed by auscultation of typical midsystolic clicks and late systolic murmurs or by echocardiographic demonstration of definite systolic protrusion of the mitral leaflets into the left atrium, is the commonest human abnormality of heart valves, affecting roughly 4 per cent of the population. The most important clinical features of mitral valve prolapse include palpitations and small but definite risks of infective endocarditis or significant mitral regurgitation in middle age, or later. Current evidence suggests that mitral prolapse is due to an inherited abnormality in connective tissue, which causes thoracic bony abnormalities and reduced body weight and blood pressure, in addition to the changes in the mitral valve.

Adolescent↗

PubMed1991

Recurrent cerebral infarction during anticoagulation therapy in patients with mitral valve prolapse.

Mitral valve prolapse has been associated with an increased risk of transient or lasting ischemic events. Recurrence is uncommon after initiation of antiplatelet or anticoagulant therapy. In this communication we report two patients, both female, who had mitral valve prolapse as the major risk factor for cerebrovascular disease and who developed cerebral infarction despite anticoagulation. The cerebral infarctions were bilateral and extensive in one patient and led to the patient's death. In the second case, three infarctions resulted in moderate disability.

Adult↗