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Apostolou F, Ioannides M, Mitsis A, Koutsofti C, Deltas C, Avraamides P. Case report: Aborted sudden cardiac death as a first presentation of severe mitral annulus disjunction-a case series and review of the literature. Front Cardiovasc Med 2023; 10:1171226. [PMID: 37547253 PMCID: PMC10400284 DOI: 10.3389/fcvm.2023.1171226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Mitral annulus disjunction (MAD) is defined as a systolic displacement between the ventricular myocardium and the posterior mitral annulus supporting the posterior mitral leaflet. This structural abnormality is associated with the loss of mechanical annular function manifested as an abnormal systolic excursion of the leaflet hinge point into the left atrium but with maintained electrical function, separating the left atrium and ventricle electrophysiologically. The mitro-aortic fibrous continuity limits MAD anteriorly, between the aortic cusps and the anterior leaflet of the mitral valve. Consequently, MAD has been observed only at the insertion of the posterior leaflet. It can extend preferentially at the central posterior scallop. The first diagnostic modality aiding the diagnosis is transthoracic echocardiography (TTE), although in some cases adjunctive cardiac imaging modality might be suggested. MAD carries a strong association with malignant ventricular arrhythmogenesis and a profound predisposition for sudden cardiac death (SCD). In this context, a thorough investigation of this morphological and functional abnormality is vital in estimating the risk assessment and stratification for optimal management and elimination of the risk of the patient for SCD. Based on the current scientific data and literature, we will discuss the diagnosis, clinical implications, risk stratification, and therapeutic management of MAD.
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Affiliation(s)
- Fay Apostolou
- Department of Cardiology, Nicosia General Hospital,Strovolos, Cyprus
| | - Marios Ioannides
- Department of Cardiology, Nicosia General Hospital,Strovolos, Cyprus
| | - Andreas Mitsis
- Department of Cardiology, Nicosia General Hospital,Strovolos, Cyprus
| | - Constantina Koutsofti
- Biobank.cy Center of Excellence in Biobanking and Biomedical Research, University of Cyprus,Nicosia, Cyprus
| | - Constantinos Deltas
- Biobank.cy Center of Excellence in Biobanking and Biomedical Research, University of Cyprus,Nicosia, Cyprus
- School of Medicine, University of Cyprus, Nicosia, Cyprus
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Jaouadi H, Théron A, Hourdain J, Martel H, Nguyen K, Habachi R, Deharo JC, Collart F, Avierinos JF, Zaffran S. SCN5A Variants as Genetic Arrhythmias Triggers for Familial Bileaflet Mitral Valve Prolapse. Int J Mol Sci 2022; 23:ijms232214447. [PMID: 36430924 PMCID: PMC9692711 DOI: 10.3390/ijms232214447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
Mitral valve prolapse (MVP) is a common valvular heart defect with variable outcomes. Several studies reported MVP as an underestimated cause of life-threatening arrhythmias and sudden cardiac death (SCD), mostly in young adult women. Herein, we report a clinical and genetic investigation of a family with bileaflet MVP and a history of syncopes and resuscitated sudden cardiac death. Using family based whole exome sequencing, we identified two missense variants in the SCN5A gene. A rare variant SCN5A:p.Ala572Asp and the well-known functional SCN5A:p.His558Arg polymorphism. Both variants are shared between the mother and her daughter with a history of resuscitated SCD and syncopes, respectively. The second daughter with prodromal MVP as well as her healthy father and sister carried only the SCN5A:p.His558Arg polymorphism. Our study is highly suggestive of the contribution of SCN5A mutations as the potential genetic cause of the electric instability leading to ventricular arrhythmias in familial MVP cases with syncope and/or SCD history.
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Affiliation(s)
- Hager Jaouadi
- Marseille Medical Genetics, INSERM, Aix Marseille Université, U1251 Marseille, France
- Correspondence: (H.J.); (S.Z.); Tel.: +33-4-9132-4936 (H.J. & S.Z.); Fax: +33-4-9179-7227 (H.J. & S.Z.)
| | - Alexis Théron
- Marseille Medical Genetics, INSERM, Aix Marseille Université, U1251 Marseille, France
- Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France
| | - Jérôme Hourdain
- Department of Cardiology, La Timone Hospital, 13005 Marseille, France
| | - Hélène Martel
- Department of Cardiology, La Timone Hospital, 13005 Marseille, France
| | - Karine Nguyen
- Marseille Medical Genetics, INSERM, Aix Marseille Université, U1251 Marseille, France
- Department of Medical Genetics, Timone Enfant Hospital, 13005 Marseille, France
| | - Raja Habachi
- Department of Cardiology, La Timone Hospital, 13005 Marseille, France
| | | | - Frédéric Collart
- Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France
| | - Jean-François Avierinos
- Marseille Medical Genetics, INSERM, Aix Marseille Université, U1251 Marseille, France
- Department of Cardiology, La Timone Hospital, 13005 Marseille, France
| | - Stéphane Zaffran
- Marseille Medical Genetics, INSERM, Aix Marseille Université, U1251 Marseille, France
- Correspondence: (H.J.); (S.Z.); Tel.: +33-4-9132-4936 (H.J. & S.Z.); Fax: +33-4-9179-7227 (H.J. & S.Z.)
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Malignant Mitral Valve Prolapse: Risk and Prevention of Sudden Cardiac Death. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2022; 24:61-86. [PMID: 35784809 PMCID: PMC9241643 DOI: 10.1007/s11936-022-00956-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Purpose of review The purpose of this review is to explore the prevalence and risk factors for a malignant phenotype in mitral valve prolapse (MVP) characterized by life-threatening ventricular arrhythmias and sudden cardiac arrest and death (SCD), including mechanistic and pathophysiologic findings and mechanism-based potential therapies. Recent findings A malignant phenotype in MVP characterized by life-threatening arrhythmias has long been recognized, although MVP is often benign. Efforts to identify this malignant phenotype have revealed potential risk factors for SCD that include elongated, myxomatous leaflets, ECG changes and complex ventricular ectopy. More recently, malignant MVP has been associated with myocardial fibrosis in the papillary muscles and inferobasal left ventricular wall. This localization suggests a central role of prolapse-induced mechanical forces on the myocardium in creating an arrhythmogenic substrate and triggering life-threatening arrhythmias. This mechanism for fibrosis is also consistent with imaging evidence of prolapse-induced mechanical changes in the papillary muscles and inferobasal left ventricular wall. Currently, no therapy to prevent SCD in malignant MVP has been established and limited clinical data are available. Mechanistic information and prospective study have the potential to identify patients at risk of SCD and preventive strategies. Summary Malignant MVP relates to unique properties and mechanical abnormalities in the mitral valve apparatus and adjacent myocardium. Increased understanding of disease mechanisms and determinants of arrhythmias is needed to establish effective therapies.
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CLINICAL AND DIAGNOSTIC ASPECTS OF MANAGING PATIENTS WITH VALVULAR HEART DISEASE. WORLD OF MEDICINE AND BIOLOGY 2022. [DOI: 10.26724/2079-8334-2022-2-80-178-183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Spartalis M, Tzatzaki E, Spartalis E, Athanasiou A, Moris D, Damaskos C, Garmpis N, Voudris V. Mitral valve prolapse: an underestimated cause of sudden cardiac death-a current review of the literature. J Thorac Dis 2017; 9:5390-5398. [PMID: 29312750 DOI: 10.21037/jtd.2017.11.14] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mitral valve prolapse (MVP) is a common valve abnormality in general population. Despite the general belief of a benign disorder, several articles since the 1980s report sudden cardiac death (SCD) in MVP patients, with a substantial percentage of asymptomatic young individuals. The problem is to detect those patients at increased risk and implement methods that are suitable to prevent cardiac arrest. This review investigates the correlation between MVP and SCD, the understanding of the pathophysiology, the strategies for detecting those at risk and treatment options. A complete literature survey was performed using PubMed database search to gather available information regarding MVP and SCD. A total of 33 studies met selection criteria for inclusion in the review. MVP is an underrated cause of arrhythmic SCD. The subset of patients with malignant MVP who may be at greater risk for SCD is characterized by young women with bileaflet MVP, biphasic or inverted T waves in the inferior leads, and frequent complex ventricular ectopic activity with documented ventricular bigeminy or ventricular tachycardia (VT) and premature ventricular contractions (PVCs) configurations of outflow tract alternating with fascicular origin or papillary muscle. MVP is a common condition in the general population and is often encountered in asymptomatic individuals. The existing literature continues to generate significant controversy regarding the association of MVP with ventricular arrhythmias and SCD. Early echocardiography and cardiac magnetic resonance (CMR) are essential, as is a greater understanding of the potential electrophysiological processes of primary arrhythmogenesis and the evaluation of the genetic substrate.
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Affiliation(s)
- Michael Spartalis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Eleni Tzatzaki
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens, Medical School, Athens, Greece
| | | | - Demetrios Moris
- Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Christos Damaskos
- Laboratory of Experimental Surgery and Surgical Research, University of Athens, Medical School, Athens, Greece
| | - Nikolaos Garmpis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens, Medical School, Athens, Greece
| | - Vassilis Voudris
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
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Abstract
Echodynamics refers to the use of echocardiography as hemodynamic tool mostly in intensive and acute care settings. It implies a smooth drift from the classic cardiology use to a more critical care adjusted use. A more personalized approach is advocated in critical care, and echo is one way to reach such goal. Correct application necessitates optimum understanding, interpretation, and finally integration into patients' clinical management. As more critical care doctors are advancing from basic focused echo examinations to a more advanced one, this article is trying to underlie many pitfalls of critical care echocardiography in order to guide better practice.
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Affiliation(s)
- Ashraf Roshdy
- 1 Critical Care Department, Alexandria University, Alexandria, Egypt.,2 General ICU, Broomfield Hospital, Mid Essex NHS Trust, Broomfield, Chelmsford, United Kingdom
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