Mitral valve prolapse: «Much Ado About Nothing», or a real unsolved problem?
Abstract
The paper discusses the modern state of the mitral valve prolapse (MVP) problem. Controversial and unresolved issues on terminology, diagnostics, and tactics for different MVP variants are considered on the basis of the “Heritable disorders of connective tissue” recommendations (2009) by Expert Committee, the Society of Cardiology of the Russian Federation (VNOK). The modern diagnostic criteria of MVP are discussed, as well as echocardiography-estimated MVP prevalence while using those diagnostic criteria, and the comparison of Framingham Heart Study results to the authors’ own data. The interrelation between autonomic dysfunction and MVP is assessed, and different approaches to the stratification of MVP complication risk are compared, based on the echocardiography results and clinical data. The modern methods of MVP treatment and management strategy are also described.
About the Authors
E. V. Zemtsovsky
V.A. Almazov Federal Centre of Heart, Blood, and Endocrinology;
St. Petersburg State Pediatrics Medical Academy. St. Petersburg
Russian Federation
Russian Federation
E. G. Malev
V.A. Almazov Federal Centre of Heart, Blood, and Endocrinology
Russian Federation
Russian Federation
S. V. Reeva
V.A. Almazov Federal Centre of Heart, Blood, and Endocrinology;
St. Petersburg State Pediatrics Medical Academy. St. Petersburg
Russian Federation
Russian Federation
References
1. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. JACC 2006; 48(3): e1-148.
2. Devereux RB, Kramer-Fox R, Kligfield P. Mitral valve prolapse: causes, clinical manifestations, and management. Ann Intern Med 1989; 111: 305-17.
3. Waller BF, Morrow AG, Maron BJ, et al. Etiology of clinically isolated, severe, chronic, pure mitral regurgitation: analysis of 97 patients over 30 years of age having mitral valve replacement. Am Heart J 1982; 104: 276-88.
4. Freed LA, Levy D, Levine RA, et al. Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med 1999; 341: 1-7.
5. Levine RA, Triulzi MO, Harrigan P, Weyman AE. The relationship of mitral annular shape to the diagnosis of mitral valve prolapse. Circulation 1987; 75: 756-67.
6. Levine RA, Handschumacher MD, Sanfilippo AJ, et al. Threedimensional echocardiographic reconstruction of the mitral valve, with implications for the diagnosis of mitral valve prolapse. Circulation 1989; 80: 589-98.
7. Freed LA, Benjamin EJ, Levy D, et al. Mitral valve prolapse in the general population: the benign nature of echocardiographic features in the Framingham Heart Study. JACC 2002; 40: 1298-304.
8. Allen H, Harris A, Leatham A. Significance and prognosis of an isolated late systolic murmur: a 9- to 22-year follow-up. Br Heart J 1974; 36: 525-32.
9. Mills P, Rose J, Hollingsworth J, et al. Long-term prognosis of mitral valve prolapse. N Engl J Med 1977; 297: 13- 8.
10. Devereux RB, Brown WT, Kramer-Fox R, Sachs I. Inheritance of mitral valve prolapse: effect of age and sex on gene expression. Ann Intern Med 1982; 97: 826-32.
11. Fontana ME, Sparks EA, Boudoulas H, Wooley CF. Mitral valve prolapse and the mitral valve prolapse syndrome. Curr Probl Cardiol 1991; 16: 309-75.
12. Clemens JD, Horwitz RI, Jaffe CC, et al. A controlled evaluation of the risk of bacterial endocarditis in persons with mitral-valve prolapse. N Engl J Med 1982; 307: 776-81.
13. Devereux RB, Frary CJ, Kramer-Fox R, et al. Cost-effectiveness of infective endocarditis prophylaxis for mitral valve prolapse with or without a mitral regurgitant murmur. Am J Cardiol 1994; 74: 1024-9.
14. Wilson LA, Keeling PW, Malcolm AD, et al. Visual complications of mitral leaflet prolapse. Br Med J 1977; 2: 86-8.
15. Barnett HJ, Boughner DR, Taylor DW, et al. Further evidence relating mitral-valve prolapse to cerebral ischemic events. N Engl J Med 1980; 302: 139-44.
16. Vohra J, Sathe S, Warren R, et al. Malignant ventricular arrhythmias in patients with mitral valve prolapse and mild mitral regurgitation. Pacing Clin Electrophysiol 1993; 16: 387-93.
17. Chandraratna PA, Nimalasuriya A, Kawanishi D, et al. Identification of the increased frequency of cardiovascular abnormalities associated with mitral valve prolapse by twodimensional echocardiography. Am J Cardiol 1984; 54: 1283-5.
18. NishimuraRA,McGoonMD,ShubC,etal.Echocardiographically documented mitral-valve prolapse: long-term follow-up of 237 patients. N Engl J Med 1985; 313: 1305-9.
19. Marks AR, Choong CY, Sanfilippo AJ, et al. Identification of high-risk and low-risk subgroups of patients with mitral-valve prolapse. N Engl J Med 1989; 320: 1031-6.
20. Takamoto T, Nitta M, Tsujibayashi T, et al. The prevalence and clinical features of pathologically abnormal mitral valve leaflets (myxomatous mitral valve) in the mitral valve prolapse syndrome: an echocardiographic and pathological comparative study. J Cardiol Suppl 1991; 25: 75-86.
21. Babuty D, Cosnay P, Breuillac JC, et al. Ventricular arrhythmia factors in mitral valve prolapse. Pacing Clin Electrophysiol 1994; 17: 1090-9.
22. Zuppiroli A, Mori F, Favilli S, et al. Arrhythmias in mitral valve prolapse: relation to anterior mitral leaflet thickening, clinical variables, and color Doppler echocardiographic parameters. Am Heart J 1994; 128: 919-27.
23. Zuppiroli A, Rinaldi M, Kramer-Fox R, et al. Natural history of mitral valve prolapse. Am J Cardiol 1995; 75: 1028-32.
24. Rosen SE, Borer JS, Hochreiter C, et al. Natural history of the asymptomatic/minimally symptomatic patient with severe mitral regurgitation secondary to mitral valve prolapse and normal right and left ventricular performance. Am J Cardiol 1994; 74: 374-80.
25. Schaal SF. Ventricular arrhythmias in patients with mitral valve prolapse. Cardiovasc Clin 1992; 22: 307-16.
26. Pepi M, Tamborini G, Maltagliati A, et al. Head-to-head comparison of two- and three-dimensional transthoracic and transesophageal echocardiography in the localization of mitral valve prolapse. JACC 2006; 48(12): 2524-30.
27. Devereux RB. Mitral valve prolapse. J Am Med Womens Assoc 1994; 49(6): 192-7.
28. Сторожаков Г.И., Верещагина Г.С., Малышева Н.В. Стратификация риска и выбор клинической тактики у пациентов с пролапсом митрального клапана. Серд недостат 2001; 1(6).
29. Avierinos JF, Gersh BJ, Melton LJ, 3rd et al. Natural history
Review
For citations:
Zemtsovsky E.V., Malev E.G., Reeva S.V. Mitral valve prolapse: «Much Ado About Nothing», or a real unsolved problem? Cardiovascular Therapy and Prevention. 2010;9(8):69-74. (In Russ.)
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