Angiographic diagnosis of posterior mitral valve leaflet prolapse

Mitral valve prolapse in patients with pure rheumatic mitral stenosis: an angiographic study

Of 122 adult patients suspected of having rheumatic mitral stenosis, 112 fulfilled the hemodynamic and angiographic criteria for pure, isolated mitral stenosis. There were 88 females and 24 males with an age range of 16 to 60 years. The left ventriculograms (30 degrees right anterior oblique) were subjectively assessed for gross bulging of the mitral valve leaflets beyond the mitral fulcrum into the left atrium during a beat with maximal opacification. Seventeen percent of cases had typical evidence of mitral valve prolapse, which is much higher than the 3% to 5% rate reported for the general population. This phenomenon was independent of the patients' age, sex, hemodynamic findings, and/or their underlying cardiac rhythm, thus implying the direct role of rheumatic mitral stenosis in the genesis of secondary mitral valve prolapse.

Mitral valve prolapse, panic disorder, and chest pain

Mitral valve prolapse is a common cardiac disorder that can readily be diagnosed by characteristic auscultatory and echocardiographic criteria. Although many diseases have been associated with mitral valve prolapse, most affected individuals have the primary form of the disorder. Mitral valve prolapse is an inherited condition commonly associated with myxomatous degeneration of the mitral valve and its support structures. Complications of mitral valve prolapse, including cardiac arrhythmias, sudden death, infective endocarditis, severe mitral regurgitation (with or without chordae tendineae rupture), and cerebral ischemic events, occur infrequently considering the wide prevalence of the disorder. Panic disorder is a specific type of anxiety disorder characterized by at least three panic attacks within a 3-week period or one panic attack followed by fear of subsequent panic attacks for at least 1 month. It too is a common condition with a prevalence and age and gender distribution similar to that of mitral valve prolapse. Panic disorder and mitral valve prolapse share many nonspecific symptoms, including chest pain or discomfort, palpitations, dyspnea, effort intolerance, and pre-syncope. Chest pain is the symptom in both conditions that most commonly brings the patient to medical attention. The clinical description of chest pain in patients with mitral valve prolapse is highly variable, possibly reflecting multiple etiologies. Chest pain in panic disorder is usually characterized as atypical angina pectoris and as such bears resemblance to the chest pain commonly described by patients with mitral valve prolapse. Multiple investigative attempts to elucidate the mechanism of chest pain in both conditions have failed to identify a unifying cause. Review of the literature leaves little doubt that mitral valve prolapse and panic disorder frequently co-occur. Given the similarities in their symptomatology, a high rate of co-occurrence is, in fact, entirely predictable. There is, however, no convincing evidence of a cause-effect relationship between the two disorders, nor has a single pathophysiologic or biochemical mechanism been identified that unites these two common conditions. Until specific biologic markers for these disorders are identified, it may be impossible to do so. The lack of a proven cause-and-effect relationship between mitral valve prolapse and panic disorder and the absence of a unifying mechanism do not diminish the clinical significance of the high rate of co-occurrence between the two conditions. Primary care physicians and cardiologists frequently encounter patients with mitral valve prolapse and nonspecific symptoms with no discernible objective cause who fail to respond to beta-blockade. Panic disorder should be considered as a possible explanation for symptoms in such patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Left ventricular dysfunction in symptomatic mitral valve prolapse

Idiopathic MVP is characterized by a late systolic click or murmur from myxomatous mitral valvular dysfunction. It may be complicated by atypical chest pain, ventricular arrhythmias, and ECG changes that can mimic the symptoms of coronary artery disease. We prospectively performed radionuclide cineangiograms before and after stress tests in MVP patients with chest pain compared with asymptomatic MVP patients and symptomatic normal control patients. In ten patients with MVP, chest pain, and normal coronary anatomy, the LVEF remained essentially unchanged (increase of -0.5 +/- 4 percent) after exercise. In ten patients with MVP and no chest pain and in nine with normal cardiovascular system and chest pain, the exercise LVEF increased by 11.5 +/- 2 percent (p less than 0.05) and 17.4 +/- 3 percent (p less than 0.005), respectively. The resting LVEF was significantly lower (p less than 0.02) in the symptomatic MVP patients (59 +/- 3 percent) than in the asymptomatic MVP (76 +/- 5 percent) or symptomatic normal patient control subjects (70 +/- 3 percent). Patients with MVP and chest pain had a lower resting LVEF and an abnormal left ventricular functional response to exercise compared with asymptomatic MVP patients or symptomatic normal subjects. Therefore, exercise radionuclide ventriculography may not adequately differentiate between chest pain due to MVP or coronary artery disease.

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.