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Clinical Cardiology Jun 1982This study considers the implications that two types of mitral valve prolapse exist. One is primary, and consists of a basic abnormality of the mitral apparatus. While... (Review)
Review
This study considers the implications that two types of mitral valve prolapse exist. One is primary, and consists of a basic abnormality of the mitral apparatus. While the etiology of this lesion may not always be the same, the major gross abnormalities are usually constant. Secondary mitral valve prolapse generally exists merely as a consequence of reduced or abnormal ventricular dimensions, and usually appears to be a benign phenomenon.
Topics: Anorexia Nervosa; Cardiomyopathy, Hypertrophic; Funnel Chest; Heart Septal Defects, Atrial; Humans; Hypertension, Pulmonary; Mitral Valve Prolapse; Myxoma; Syndrome
PubMed: 7049478
DOI: 10.1002/clc.4960050605 -
Medical Archives (Sarajevo, Bosnia and... Feb 2018Mitral Valve Prolapse (MVP) is the most common cardiac valve pathology of to day. Aim of article was to identify the types and frequency of potentially malignant... (Comparative Study)
Comparative Study
INTRODUCTION
Mitral Valve Prolapse (MVP) is the most common cardiac valve pathology of to day. Aim of article was to identify the types and frequency of potentially malignant arrhythmia and atrial brillation in patients with MVP, to determine the differences in these arrhythmias between classical and non-classical MVP, to evaluate the correlation of potentially malignant arrhythmia and atrial fibrillation with MVP with possible clinical complications of arrhythmogenic sudden cardiac death and potential risk of thromboembolic vascular incident.
PATIENTS AND METHODS
Article has retrospective-prospective analytical character and present observational study on 239 patients (120 with MVP (66 with classical and 54 with non-classical MVP), who had a subjective feeling of palpitations and/or pain in the chest, and/or episode of syncope, and did not have ischemic heart disease or another valve pathology) and 119 healthy patients in the control group. All patients were analyzed by 24-hour ECG Holter.
RESULTS
Signifficant difference in all analyzed arrhythmias between classical MVP and control group (p <0.001) between non-classical and control group in the presence of preexcitation signs (p = 0.047), and between classical and non-classical in presence of QT prolongation and AV block of II and III degree (p = 0.023), ventricular arrhythmias of the 3rd, 4th and 5th grade at scales according to Lown (p = 0.002) and atrial brillation in favor of classical MVP (p = 0.016).
CONCLUSION
The potential risk of cardiac death and vascular incidence is signi cantly higher in classical MVP than in non-classical MVP, implying the need for routine ECG-Holter monitoring in their diagnosis for timely prevention of clinical arrhythmogenic complications.
Topics: Adolescent; Adult; Aged; Arrhythmias, Cardiac; Female; Humans; Male; Middle Aged; Mitral Valve Prolapse; Prospective Studies; Retrospective Studies; Young Adult
PubMed: 29416210
DOI: 10.5455/medarh.2018.72.9-12 -
Journal of the Royal College of... Jul 1981
Topics: Angiocardiography; Arrhythmias, Cardiac; Echocardiography; Electrocardiography; Embolism; Heart Auscultation; Heart Failure; Humans; Mitral Valve Prolapse
PubMed: 7252895
DOI: No ID Found -
Electrical markers and arrhythmic risk associated with myocardial fibrosis in mitral valve prolapse.Europace : European Pacing,... Jul 2022We aimed to characterize the substrate of T-wave inversion (TWI) using cardiac magnetic resonance (CMR) and the association between diffuse fibrosis and ventricular...
AIMS
We aimed to characterize the substrate of T-wave inversion (TWI) using cardiac magnetic resonance (CMR) and the association between diffuse fibrosis and ventricular arrhythmias (VA) in patients with mitral valve prolapse (MVP).
METHODS AND RESULTS
TWI was defined as negative T-wave ≥0.1 mV in ≥2 adjacent ECG leads. Diffuse myocardial fibrosis was assessed by T1 relaxation time and extracellular volume (ECV) fraction by T1-mapping CMR. We included 162 patients with MVP (58% females, age 50 ± 16 years), of which 16 (10%) patients had severe VA (aborted cardiac arrest or sustained ventricular tachycardia). TWI was found in 34 (21%) patients. Risk of severe VA increased with increasing number of ECG leads displaying TWI [OR 1.91, 95% CI (1.04-3.52), P = 0.04]. The number of ECG leads displaying TWI increased with increasing lateral ECV (26 ± 3% for TWI 0-1leads, 28 ± 4% for TWI 2leads, 29 ± 5% for TWI ≥3leads, P = 0.04). Patients with VA (sustained and non-sustained ventricular tachycardia) had increased lateral T1 (P = 0.004), also in the absence of late gadolinium enhancement (LGE) (P = 0.008).
CONCLUSIONS
Greater number of ECG leads with TWI reflected a higher arrhythmic risk and higher degree of lateral diffuse fibrosis by CMR. Lateral diffuse fibrosis was associated with VA, also in the absence of LGE. These results suggest that TWI may reflect diffuse myocardial fibrosis associated with VA in patients with MVP. T1-mapping CMR may help risk stratification for VA.
Topics: Adult; Aged; Arrhythmias, Cardiac; Cardiomyopathies; Contrast Media; Female; Fibrosis; Gadolinium; Humans; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Mitral Valve Prolapse; Myocardium; Predictive Value of Tests; Tachycardia, Ventricular
PubMed: 35226070
DOI: 10.1093/europace/euac017 -
Revista Portuguesa de Cardiologia :... Oct 2023Mitral annular disjunction (MAD) is an easily identifiable entity on transthoracic echocardiography, but is still poorly recognized or ignored. It is often associated... (Review)
Review
Mitral annular disjunction (MAD) is an easily identifiable entity on transthoracic echocardiography, but is still poorly recognized or ignored. It is often associated with mitral valve prolapse and is itself a risk marker for ventricular arrhythmias and sudden cardiac death, but the management and risk stratification of these patients is not systematized. Two clinical cases of MAD associated with mitral valve prolapse and ventricular arrhythmias are presented. The first case is of a patient with a history of surgical intervention on the mitral valve due to Barlow's disease. He presented to the emergency department with sustained monomorphic ventricular tachycardia requiring emergent electrical cardioversion. MAD with transmural fibrosis at the level of the inferolateral wall was documented. The second report is of a young woman with palpitations and frequent premature ventricular contractions on Holter with documentation of valvular prolapse and MAD, and focuses on the risk stratification approach. The present article offers a review of the literature regarding the arrhythmic risk of MAD and mitral valve prolapse, as well as a review of risk stratification in these patients.
Topics: Male; Female; Humans; Mitral Valve Prolapse; Mitral Valve; Arrhythmias, Cardiac; Death, Sudden, Cardiac; Echocardiography
PubMed: 37156414
DOI: 10.1016/j.repc.2019.09.024 -
Mayo Clinic Proceedings Mar 2016To determine the incidence and predictors of infective endocarditis (IE) in a population-based cohort of patients with mitral valve prolapse (MVP). (Comparative Study)
Comparative Study
OBJECTIVE
To determine the incidence and predictors of infective endocarditis (IE) in a population-based cohort of patients with mitral valve prolapse (MVP).
PATIENTS AND METHODS
We identified all adult Olmsted County residents with MVP diagnosed by echocardiography from January 1989 to December 1998 and cross-matched them with the Rochester Epidemiology Project-identified Olmsted County cases of IE from January 1, 1986, through December 31, 2006. We retrospectively analyzed and de novo confirmed each IE case using the modified Duke criteria.
RESULTS
There were 896 Olmsted County residents with echocardiographically diagnosed MVP (mean age, 53±21 years; 565 women [63%]). The mean follow-up period was 11±5 years. The 15-year cohort risk of IE after MVP diagnosis was 1.1%±0.4% (incidence, 86.6 cases per 100,000 person-years; 95% CI, 43.3-173.2 cases per 100,000 person-years); thus, the age- and sex-adjusted relative risk of IE in patients with MVP was 8.1 (95% CI, 3.6-18.0) in comparison to the general population of Olmsted County (P<.001). There were no IE cases in patients without previously diagnosed mitral regurgitation (MR). Conversely, IE incidence was higher in patients with MVP with moderate, moderate-severe, or severe MR (289.5 cases per 100,000 person-years; 95% CI, 108.7-771.2 cases per 100,000 person-years; P=.02 compared with trivial, mild, or mild-moderate MR) and in patients with a flail mitral leaflet (715.5 cases per 100,000 person-years; 95% CI, 178.9-2861.0 cases per 100,000 person-years; P=.02 compared with no flail mitral leaflet).
CONCLUSION
The population-based incidence of IE in adults with MVP is higher than those previously reported in case-control, tertiary care center studies. Patients with MVP and moderate, moderate-severe, or severe MR or a flail mitral leaflet are at a notable risk of developing IE in comparison with those without MR.
Topics: Adult; Aged; Cohort Studies; Echocardiography; Endocarditis; Female; Humans; Incidence; Male; Middle Aged; Minnesota; Mitral Valve Prolapse; Population Surveillance; Retrospective Studies; Risk Factors
PubMed: 26856780
DOI: 10.1016/j.mayocp.2015.12.006 -
Journal of the American College of... Aug 2020
Topics: Arrhythmias, Cardiac; Humans; Mitral Valve; Mitral Valve Prolapse; Rome
PubMed: 32762898
DOI: 10.1016/j.jacc.2020.06.048 -
The International Journal of... Jul 2020Mitral annular disjunction (MAD) is routinely diagnosed by cardiac imaging, mostly by echocardiography, and shown to be a risk factor for ventricular arrhythmias. While...
Mitral annular disjunction (MAD) is routinely diagnosed by cardiac imaging, mostly by echocardiography, and shown to be a risk factor for ventricular arrhythmias. While MAD is associated with mitral valve (MV) prolapse (MVP), it is unknown which patients with MAD are at higher risk and which additional imaging features may help identify them. The value of cardiac computed tomography (CCT) for the diagnosis of MAD is unknown. Accordingly, we aimed to: (1) develop a standardized CCT approach to identify MAD in patients with MVP and severe mitral regurgitation (MR); (2) determine its prevalence and identify features that are associated with MAD in this population. We retrospectively studied 90 patients (age 63 ± 12 years) with MVP and severe MR, who had pre-operative CCT (256-slice scanner) of sufficient quality for analysis. The presence and degree of MAD was assessed by rotating the view plane around the MV center to visualize disjunction along the annulus. Additionally, detailed measurements of MV apparatus and left heart chambers were performed. Univariate logistic regression analysis was performed to determine which parameters were associated with MAD. MAD was identified in 18 patients (20%), and it was typically located adjacent to a prolapsed or flail mitral leaflet scallop. Of these patients, 75% had maximum MAD distance > 4.8 mm and 90% > 3.8 mm. Female gender was most strongly associated with MAD (p = 0.04). Additionally, smaller end-diastolic mitral annulus area (p = 0.045) and longer posterior leaflet (p = 0.03) were associated with greater MAD. No association was seen between MAD and left ventricular size and function, left atrial size, and papillary muscle geometry. CCT can be used to readily detect MAD, by taking advantage of the 3D nature of this modality. A significant portion of MVP patients referred for mitral valve repair have MAD. The presence of MAD is associated with female gender, smaller annulus size and greater posterior leaflet length.
Topics: Aged; Female; Hemodynamics; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Prolapse; Multidetector Computed Tomography; Predictive Value of Tests; Prevalence; Reproducibility of Results; Retrospective Studies; Severity of Illness Index; Sex Factors
PubMed: 32221771
DOI: 10.1007/s10554-020-01818-4 -
JACC. Cardiovascular Imaging May 2008
Topics: Arrhythmias, Cardiac; Contrast Media; Echocardiography, Doppler; Fibrosis; Gadolinium DTPA; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging, Cine; Mitral Valve; Mitral Valve Prolapse; Papillary Muscles; Predictive Value of Tests
PubMed: 19225572
DOI: 10.1016/j.jcmg.2008.04.003 -
The Canadian Journal of Cardiology Sep 2014Any structural or functional impairment of the mitral valve (MV) apparatus that exhausts MV tissue redundancy available for leaflet coaptation will result in mitral... (Review)
Review
Any structural or functional impairment of the mitral valve (MV) apparatus that exhausts MV tissue redundancy available for leaflet coaptation will result in mitral regurgitation (MR). The mechanism responsible for MV malcoaptation and MR can be dysfunction or structural change of the left ventricle, the papillary muscles, the chordae tendineae, the mitral annulus, and the MV leaflets. The rationale for MV treatment depends on the MR mechanism and therefore it is essential to identify and understand normal and abnormal MV and MV apparatus function.
Topics: Chordae Tendineae; Humans; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Prolapse; Rupture
PubMed: 25151282
DOI: 10.1016/j.cjca.2014.06.022