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Barta LE, Holland HK, Costa HA, Rzepka JW, Almassi GH, Schena S, Pagel PS. Two Posterior Mitral Leaflets or a Feature of Degenerative Valve Disease That Contributes to Mitral Regurgitation? J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00320-8. [PMID: 37225549 DOI: 10.1053/j.jvca.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/07/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Lauren E Barta
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Hannah K Holland
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Heather A Costa
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Jason W Rzepka
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Stefano Schena
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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Delwarde C, Capoulade R, Mérot J, Le Scouarnec S, Bouatia-Naji N, Yu M, Huttin O, Selton-Suty C, Sellal JM, Piriou N, Schott JJ, Dina C, Le Tourneau T. Genetics and pathophysiology of mitral valve prolapse. Front Cardiovasc Med 2023; 10:1077788. [PMID: 36873395 PMCID: PMC9978496 DOI: 10.3389/fcvm.2023.1077788] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/23/2023] [Indexed: 02/18/2023] Open
Abstract
Mitral valve prolapse (MVP) is a common condition affecting 2-3% of the general population, and the most complex form of valve pathology, with a complication rate up to 10-15% per year in advanced stages. Complications include mitral regurgitation which can lead to heart failure and atrial fibrillation, but also life-threatening ventricular arrhythmia and cardiovascular death. Sudden death has been recently brought to the forefront of MVP disease, increasing the complexity of management and suggesting that MVP condition is not properly understood. MVP can occur as part of syndromic conditions such as Marfan syndrome, but the most common form is non-syndromic, isolated or familial. Although a specific X-linked form of MVP was initially identified, autosomal dominant inheritance appears to be the primary mode of transmission. MVP can be stratified into myxomatous degeneration (Barlow), fibroelastic deficiency, and Filamin A-related MVP. While FED is still considered a degenerative disease associated with aging, myxomatous MVP and FlnA-MVP are recognized as familial pathologies. Deciphering genetic defects associated to MVP is still a work in progress; although FLNA, DCHS1, and DZIP1 have been identified as causative genes in myxomatous forms of MVP thanks to familial approaches, they explain only a small proportion of MVP. In addition, genome-wide association studies have revealed the important role of common variants in the development of MVP, in agreement with the high prevalence of this condition in the population. Furthermore, a potential genetic link between MVP and ventricular arrhythmia or a specific type of cardiomyopathy is considered. Animal models that allow to advance in the genetic and pathophysiological knowledge of MVP, and in particular those that can be easily manipulated to express a genetic defect identified in humans are detailed. Corroborated by genetic data and animal models, the main pathophysiological pathways of MVP are briefly addressed. Finally, genetic counseling is considered in the context of MVP.
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Affiliation(s)
- Constance Delwarde
- Nantes Université, CHU Nantes, CNRS, INSERM, L'institut du Thorax, Nantes, France
| | - Romain Capoulade
- Nantes Université, CHU Nantes, CNRS, INSERM, L'institut du Thorax, Nantes, France
| | - Jean Mérot
- Nantes Université, CHU Nantes, CNRS, INSERM, L'institut du Thorax, Nantes, France
| | - Solena Le Scouarnec
- Nantes Université, CHU Nantes, CNRS, INSERM, L'institut du Thorax, Nantes, France
| | | | - Mengyao Yu
- Human Phenome Institute, Fudan University, Shanghai, China
| | - Olivier Huttin
- Service de Cardiologie, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, CHU de Nancy, Nancy, France
| | - Christine Selton-Suty
- Service de Cardiologie, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, CHU de Nancy, Nancy, France
| | - Jean-Marc Sellal
- Service de Cardiologie, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, CHU de Nancy, Nancy, France
| | - Nicolas Piriou
- Nantes Université, CHU Nantes, CNRS, INSERM, L'institut du Thorax, Nantes, France
| | - Jean-Jacques Schott
- Nantes Université, CHU Nantes, CNRS, INSERM, L'institut du Thorax, Nantes, France
| | - Christian Dina
- Nantes Université, CHU Nantes, CNRS, INSERM, L'institut du Thorax, Nantes, France
| | - Thierry Le Tourneau
- Nantes Université, CHU Nantes, CNRS, INSERM, L'institut du Thorax, Nantes, France
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Lazicki TJ, Harvey JF, Rokkas CK, Tawil JN, Pagel PS. Dancing in the Dark: A Thin, Highly Mobile, Serpiginous Structure Rhythmically Protruding Into and Out of the Left Ventricular Outflow Tract. J Cardiothorac Vasc Anesth 2019; 34:1382-1384. [PMID: 31706851 DOI: 10.1053/j.jvca.2019.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/11/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Timothy J Lazicki
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Julie F Harvey
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Chris K Rokkas
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Justin N Tawil
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Paul S Pagel
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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Le Tourneau T, Mérot J, Rimbert A, Le Scouarnec S, Probst V, Le Marec H, Levine RA, Schott JJ. Genetics of syndromic and non-syndromic mitral valve prolapse. Heart 2018; 104:978-984. [PMID: 29352010 DOI: 10.1136/heartjnl-2017-312420] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/27/2017] [Accepted: 11/27/2017] [Indexed: 11/04/2022] Open
Abstract
Mitral valve prolapse (MVP) is a common condition that affects 2%-3% of the general population. MVP is thought to include syndromic forms such as Marfan syndrome and non-syndromic MVP, which is the most frequent form. Myxomatous degeneration and fibroelastic deficiency (FED) are regarded as two different forms of non-syndromic MVP. While FED is still considered a degenerative disease associated with ageing, frequent familial clustering has been demonstrated for myxomatous MVP. Familial and genetic studies led to the recognition of reduced penetrance and large phenotypic variability, and to the identification of prodromal or atypical forms as a part of the complex spectrum of the disease. Whereas autosomal dominant mode is the common inheritance pattern, an X linked form of non-syndromic MVP was recognised initially, related to Filamin-A gene, encoding for a cytoskeleton protein involved in mechanotransduction. This identification allowed a comprehensive description of a new subtype of MVP with a unique association of leaflet prolapse and paradoxical restricted motion in diastole. In autosomal dominant forms, three loci have been mapped to chromosomes 16p11-p12, 11p15.4 and 13q31-32. Although deciphering the underlying genetic defects is still a work in progress, DCHS1 mutations have been identified (11p15.4) in typical myxomatous disease, highlighting new molecular pathways and pathophysiological mechanisms leading to the development of MVP. Finally, a large international genome-wide association study demonstrated the implication of frequent variants in MVP development and opened new directions for future research. Hence, this review focuses on phenotypic, genetic and pathophysiological aspects of MVP.
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Affiliation(s)
- Thierry Le Tourneau
- l'institut du thorax, INSERM, CNRS, Université de Nantes, Nantes, France.,l'institut du thorax, CHU de Nantes, Nantes, France
| | - Jean Mérot
- l'institut du thorax, INSERM, CNRS, Université de Nantes, Nantes, France
| | - Antoine Rimbert
- l'institut du thorax, INSERM, CNRS, Université de Nantes, Nantes, France
| | | | - Vincent Probst
- l'institut du thorax, INSERM, CNRS, Université de Nantes, Nantes, France.,l'institut du thorax, CHU de Nantes, Nantes, France
| | - Hervé Le Marec
- l'institut du thorax, INSERM, CNRS, Université de Nantes, Nantes, France.,l'institut du thorax, CHU de Nantes, Nantes, France
| | - Robert A Levine
- Cardiac Ultrasound Laboratory, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jean-Jacques Schott
- l'institut du thorax, INSERM, CNRS, Université de Nantes, Nantes, France.,l'institut du thorax, CHU de Nantes, Nantes, France
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