Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Mitral Valve Prolapse in Emergency Medicine

  • Author: Michael C Plewa, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
 
Updated: Aug 03, 2016
 

Background

Mitral valve prolapse (MVP) is generally a benign condition, yet it is also an important contributing risk factor for arrhythmias, endocarditis, stroke,[1] mitral regurgitation (MR), mitral valve replacement (MVR) surgery,[2] and sudden death.[3]  Although now considered to be much less common in the general population than previously described,[4, 5] MVP is associated with a multitude of other medical conditions, especially connective tissue disorders, as well as migraine (especially migraine with aura),[6] autoimmune disease,[7]  open-angle glaucoma,[8] straight back syndrome (shown in the image below), and idiopathic sudden sensorineural hearing loss.[9]

MVP likely progresses over time, beginning in some instances with "nondiagnostic MVP morphology" (NDM) on echocardiography,[10] and occasionally progressing to MR over decades. Many individuals are asymptomatic, although palpitations, fatigue, and orthostasis are not uncommon, especially when the patient is volume depleted. Symptoms of chest pain, dyspnea, anxiety, and panic[11] are probably no more common with MVP than in the general population.

Mitral valve prolapse. A patient with straight bac Mitral valve prolapse. A patient with straight back syndrome.
Next

Pathophysiology

A myxomatous degeneration from collagen dissolution leads to excess mucopolysaccharides in the middle spongiosa layer of the mitral valve leaflets, resulting in stretching of the leaflets and the chordae tendineae. Mitral valve prolapse (MVP) occurs when the left ventricular (LV) size is small in comparison to an enlarged mitral annulus, leaflets, or chordae tendineae, and it can be induced in healthy women with typical body habitus following dehydration that is reversed with rehydration. Mitral valve prolapse resolves during pregnancy and following weight gain in anorexic patients.

Studies have shown that abnormalities of elastic fibers found in floppy mitral valves are related to genetic variants in fibrillin, one of the components of the microfibrils, as well as elastin and collagen I and II.[12] Mitral valve prolapse is associated with a variety of medical conditions involving connective tissues, such as joint hypermobility disorders,[13] and Ehlers Danlos and Marfan syndromes. Mitral valve prolapse is also associated with autoimmune disorders such as systemic lupus erythematosus and autoimmune thyroid disease; many patients with mitral valve prolapse have positive autoantibodies including ANA, rheumatoid factor, and anticardiolipin antibody.[7]

A constellation of abnormalities (eg, increased sensitivity to adrenergic stimuli, increased catecholamines, abnormal beta-receptors, increased atrial natriuretic factor, renin-aldosterone dysregulation, decreased intravascular volume, magnesium deficiency)[14] has been thought to lead to chest pain, dyspnea, fatigue, dizziness, near-syncope symptoms, and anxiety in a subset of patients with mitral valve prolapse.[15, 16]

Cardiac manifestations include supraventricular more so than ventricular arrhythmias, palpitations, mitral regurgitation, bacterial endocarditis, and sudden death. Chest pain may not be more common in patients with mitral valve prolapse than in the general population, and it may be attributed to myofascial syndromes, hyperventilation, coronary spasm, esophageal dysmotility, or gastroesophageal reflux.[17]

Mitral valve prolapse can result in cerebrovascular ischemia, which may be related to abnormal platelet activity or coagulation disorders (eg, anticardiolipin antibody, protein C or S deficiencies).

Previous
Next

Etiology

Most cases of mitral valve prolapse (MVP) are primary, idiopathic in nature, and expressed as an autosomal dominant trait that exhibits both sex- and age-dependent penetrance.[18]

Connective tissue disorders

Connective tissue conditions that may lead to MVP include the following:

  • Marfan syndrome
  • Ehlers-Danlos syndrome (ie, types I, II, IV)
  • Osteogenesis imperfecta
  • Pseudoxanthoma elasticum
  • Polycystic kidney disease
  • Stickler syndrome
  • Systemic lupus erythematosus
  • Relapsing polychondritis
  • Polyarteritis nodosa

Muscle disorders

Duchenne muscular dystrophy, fragile X syndrome, mucopolysaccharidoses, and myotonic dystrophy may lead to the development of MVP.

Heart diseases

Congenital heart disease (eg, atrial septal defect [ASD], Ebstein anomaly, and acquired heart disease (eg, papillary muscle dysfunction [eg, ischemia, myocarditis], cardiac trauma, post mitral valve surgery, rheumatic endocarditis) can cause MVP.

Miscellaneous

Wolff-Parkinson-White syndrome and von Willebrand disease may also lead to MVP.

Previous
Next

Epidemiology

United States data

Mitral valve prolapse (MVP) can be identified by echocardiography in an estimated 0.3%[5] to 3% of the general population, and it is identified in 7% of autopsies.

International data

The worldwide incidence of mitral valve prolapse is similar to that in the United States.

Race-, sex-, and age-related demographics

The prevalence of MVP is similar among different ethnic groups.[19]

The female-to-male ratio is approximately 3:1. However, men have a higher risk than women of endocarditis, posterior prolapse, leaflet thickening, severe regurgitation, and men are more likely to undergo mitral valve surgery.[20]

The age of MVP onset is 10-16 years. MVP is uncommon before the adolescent growth spurt occurs, thus, it usually is detected in young adulthood. Although MVP is considered congenital, echocardiographic findings typically are absent in newborns.

Previous
Next

Prognosis

Mortality/morbidity

In general, mitral valve prolapse (MVP) is initially a benign disorder, and in most situations, the prognosis is excellent. However, MVP may account for the majority of isolated cases of mitral regurgitation (MR), 90% of cases of ruptured chordae tendineae, 40% of strokes in young patients, and 10-15% of cases of endocarditis.[21]

MR is the most significant risk factor for other complications (eg, sudden death, stroke, endocarditis, atrial and ventricular arrhythmia[22, 23] ). Patients whose echocardiograms shows abnormal valve anatomy, men, and those older than 45 years are at an increased risk of developing MR.

Those with structural abnormalities (ie, thickened, deformed, or redundant mitral valve leaflets) are more likely to suffer complications (eg, progressive MR, endocarditis, sudden death), although a longitudinal study of 285 residents in Olmsted County, MN, suggests that progression of MR occurs in nearly 40% of MVP cases, regardless of age, gender, leaflet thickening, or initial grade of MR.[24]

Left ventricular (LV) remodeling, with elevated LV end-systolic volume index and LV end-systolic dimension, occurs even with isolated late systolic MR murmur similar to that seen with pan-systolic MR murmur.[25]

Patients who are older, lack social support, have higher anxiety, and fail to exercise regularly are at risk for more symptoms.

Cardiovascular mortality is predicted the most by moderate-to-severe MR and ejection fraction less than 50%, and less so by left atrial size greater than 40 mm, flail leaflet, atrial fibrillation, and age older than 50 years.[26, 27]

Cases of MVP with a murmur and not just an isolated click have a general mortality rate that is increased by 15-20%.

Complications

For the following complications, the absolute risk (ie, annual incidence) and the odds ratios (OR), comparing patients with mitral valve prolapse (MVP) to the general population, are as follows:

  • Sudden cardiac death - 0.06% annual incidence among patients with MVP and severe MR; OR of 50-100 with hemodynamically significant MR and depressed left ventricular function
  • Rupture of chordae tendineae (the most frequent serious complication of MVP)
  • Progressive MR - 0.06% annual incidence of requiring surgery; lifetime risk of surgery is 1.5% for women and 4-6% for men; OR of 30-40; increased risk in males, older than 75 years, elevated body weight, and high blood pressure.
  • Stroke - 0.02% annual incidence versus less than 0.02% in uncomplicated MVP; OR of 4-6
  • Infective endocarditis - 0.02% annual incidence; OR of 3-8; 1 in 1400 patients per year with MVP and murmur; increased risk in males older than 45 years
  • Atrial fibrillation can be persistent in 15% or paroxysmal in 13% when MR is severe enough to require mitral valve replacement (MVR) surgery. These rates are lower than seen with mitral stenosis requiring MVR. [28]
  • Atrial and ventricular arrhythmias are more common in those patients with mitral valve prolapse and moderate-to-severe MR. [22, 23]
  • Individuals with idiopathic sudden sensorineural hearing loss (ISSNHL) have a higher incidence of MVP, mitral leaflet thickening, and MR, suggesting that MVP may be involved in the etiology of this sudden hearing loss. [9]
Previous
Next

Patient Education

Patients with a murmur, patients who have echo evidence of nontrivial MR, or men older than 45 years who have valve thickening should inform their dentist and surgeon, although antibiotic prophylaxis prior to dental, respiratory, or infected skin or musculoskeletal tissue procedures would only be indicated if there was a history of infective endocarditis.[29]

Patients with palpitations should avoid caffeine, alcohol, stimulants, and smoking.

Symptoms of the classic mitral valve prolapse (MVP) syndrome may improve with exercise, meditation, and biofeedback.

For patient education resources, see Heart Health Center, as well as Mitral Valve Prolapse, Chest Pain, and Palpitations.

Previous
 
 
Contributor Information and Disclosures
Author

Michael C Plewa, MD Research Coordinator, Consulting Staff, Department of Emergency Medicine, Lucas County Emergency Physicians, Inc, and Mercy Saint Vincent Medical Center

Michael C Plewa, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Physicians for Social Responsibility, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Richard Worthington, MD Department of Emergency Medicine, Wood County Hospital

Richard Worthington, MD is a member of the following medical societies: American College of Emergency Physicians, Ohio State Medical Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Paul Blackburn, DO, FACOEP, FACEP Attending Physician, Department of Emergency Medicine, Maricopa Medical Center

Paul Blackburn, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, Arizona Medical Association, American College of Osteopathic Emergency Physicians, American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Robert M McNamara, MD, FAAEM Chair and Professor, Department of Emergency Medicine, Temple University School of Medicine

Robert M McNamara, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Pennsylvania Medical Society, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References
  1. Avierinos JF, Brown RD, Foley DA, et al. Cerebral ischemic events after diagnosis of mitral valve prolapse: a community-based study of incidence and predictive factors. Stroke. 2003 Jun. 34 (6):1339-44. [Medline].

  2. Singh RG, Cappucci R, Kramer-Fox R, et al. Severe mitral regurgitation due to mitral valve prolapse: risk factors for development, progression, and need for mitral valve surgery. Am J Cardiol. 2000 Jan 15. 85 (2):193-8. [Medline].

  3. Basso C, Perazzolo Marra M, Rizzo S, et al. Arrhythmic mitral valve prolapse and sudden cardiac death. Circulation. 2015 Aug 18. 132 (7):556-66. [Medline].

  4. Freed LA, Levy D, Levine RA, et al. Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med. 1999 Jul 1. 341 (1):1-7. [Medline].

  5. Turker Y, Turker Y, Baltaci D, Basar C, Akkaya M, Ozhan H, et al. The prevalence and clinical characteristics of mitral valve prolapse in a large population-based epidemiologic study: the MELEN study. Eur Rev Med Pharmacol Sci. 2015 Jun. 19 (12):2208-12. [Medline].

  6. Termine C, Trotti R, Ondei P, et al. Mitral valve prolapse and abnormalities of haemostasis in children and adolescents with migraine with aura and other idiopathic headaches: a pilot study. Acta Neurol Scand. 2010 Aug. 122 (2):91-6. [Medline].

  7. Evangelopoulos ME, Toumanidis S, Sotou D, et al. Mitral valve prolapse in young healthy individuals. An early index of autoimmunity?. Lupus. 2009 Apr. 18 (5):436-40. [Medline].

  8. Chiang SJ, Daimon M, Wang LH, Hung MJ, Chang NC, Lin HC. Association between mitral valve prolapse and open-angle glaucoma. Heart. 2015 Apr. 101 (8):609-15. [Medline].

  9. Vazquez R, Solanellas J, Alfageme I, et al. Mitral valve prolapse and sudden deafness. Int J Cardiol. 2008 Mar 14. 124 (3):370-1. [Medline].

  10. Delling FN, Rong J, Larson MG, et al. Evolution of mitral valve prolapse: insights from the Framingham Heart Study. Circulation. 2016 Apr 26. 133 (17):1688-95. [Medline].

  11. Filho AS, Maciel BC, Martín-Santos R, Romano MM, Crippa JA. Does the association between mitral valve prolapse and panic disorder really exist?. Prim Care Companion J Clin Psychiatry. 2008. 10 (1):38-47. [Medline]. [Full Text].

  12. Chou HT, Shi YR, Hsu Y, Tsai FJ. Association between fibrillin-1 gene exon 15 and 27 polymorphisms and risk of mitral valve prolapse. J Heart Valve Dis. 2003 Jul. 12 (4):475-81. [Medline].

  13. Cavenaghi S, Marino LH, Oliveira PP, Lamari NM. Joint hypermobility in patients with mitral valve prolapse. Arq Bras Cardiol. 2009 Sep. 93 (3):307-11. [Medline].

  14. Lichodziejewska B, Kłos J, Rezler J, et al. Clinical symptoms of mitral valve prolapse are related to hypomagnesemia and attenuated by magnesium supplementation. Am J Cardiol. 1997 Mar 15. 79 (6):768-72. [Medline].

  15. Scordo KA. Mitral valve prolapse syndrome: interventions for symptom control. Dimens Crit Care Nurs. 1998 Jul-Aug. 17 (4):177-86. [Medline].

  16. Fontana ME, Sparks EA, Boudoulas H, Wooley CF. Mitral valve prolapse and the mitral valve prolapse syndrome. Curr Probl Cardiol. 1991 May. 16 (5):309-75. [Medline].

  17. Kao CH, Tsai SC, Hsieh JF, Ho YJ, Ding HJ. Radionuclide esophageal transit test to detect esophageal disorders in patients with mitral valve prolapse. Nuklearmedizin. 2000. 39 (4):92-6. [Medline].

  18. Freed LA, Acierno JS Jr, Dai D, et al. A locus for autosomal dominant mitral valve prolapse on chromosome 11p15.4. Am J Hum Genet. 2003 Jun. 72 (6):1551-9. [Medline].

  19. Theal M, Sleik K, Anand S, Yi Q, Yusuf S, Lonn E. Prevalence of mitral valve prolapse in ethnic groups. Can J Cardiol. 2004 Apr. 20 (5):511-5. [Medline].

  20. Avierinos JF, Inamo J, Grigioni F, Gersh B, Shub C, Enriquez-Sarano M. Sex differences in morphology and outcomes of mitral valve prolapse. Ann Intern Med. 2008 Dec 2. 149 (11):787-95. [Medline].

  21. Yanase Y, Ishikawa N, Watanabe M, Kimura S, Higami T. Mitral valve plasty for idiopathic rupture of mitral valve posterior chordae in infants. Ann Thorac Cardiovasc Surg. 2014. 20 (2):150-4. [Medline].

  22. Turker Y, Ozaydin M, Acar G, et al. Predictors of atrial arrhythmias in patients with mitral valve prolapse. Acta Cardiol. 2009 Dec. 64 (6):755-60. [Medline].

  23. Turker Y, Ozaydin M, Acar G, et al. Predictors of ventricular arrhythmias in patients with mitral valve prolapse. Int J Cardiovasc Imaging. 2010 Feb. 26 (2):139-45. [Medline].

  24. Avierinos JF, Detaint D, Messika-Zeitoun D, Mohty D, Enriquez-Sarano M. Risk, determinants, and outcome implications of progression of mitral regurgitation after diagnosis of mitral valve prolapse in a single community. Am J Cardiol. 2008 Mar 1. 101 (5):662-7. [Medline].

  25. Ahmed MI, Sanagala T, Denney T, et al. Mitral valve prolapse with a late-systolic regurgitant murmur may be associated with significant hemodynamic consequences. Am J Med Sci. 2009 Aug. 338 (2):113-5. [Medline].

  26. Avierinos JF, Gersh BJ, Melton LJ 3rd, et al. Natural history of asymptomatic mitral valve prolapse in the community. Circulation. 2002 Sep 10. 106 (11):1355-61. [Medline].

  27. Paparella D, Guida P, Caparrotti S, et al. Myocardial damage influences short- and mid-term survival after valve surgery: a prospective multicenter study. J Thorac Cardiovasc Surg. 2014 Nov. 148 (5):2373-2379.e1. [Medline].

  28. Berbarie RF, Roberts WC. Frequency of atrial fibrillation in patients having mitral valve repair or replacement for pure mitral regurgitation secondary to mitral valve prolapse. Am J Cardiol. 2006 Apr 1. 97 (7):1039-44. [Medline].

  29. [Guideline] Wilson W, Taubert KA, Gewitz M, for the AHA Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007 Oct 9. 116 (15):1736-54. [Medline].

  30. Devereux RB, Kramer-Fox R, Kligfield P. Mitral valve prolapse: causes, clinical manifestations, and management. Ann Intern Med. 1989 Aug 15. 111 (4):305-17. [Medline].

  31. Tamam L, Ozpoyraz N, San M, Bozkurt A. Association between idiopathic mitral valve prolapse and panic disorder. Croat Med J. 2000 Dec. 41 (4):410-6. [Medline].

  32. Raggi P, Callister TQ, Lippolis NJ, Russo DJ. Is mitral valve prolapse due to cardiac entrapment in the chest Cavity? A CT view. Chest. 2000 Mar. 117 (3):636-42. [Medline].

  33. Staudacher DL, Bode C, Wengenmayer T. Severe mitral regurgitation requiring ECMO therapy treated by interventional valve reconstruction using the MitraClip. Catheter Cardiovasc Interv. 2015 Jan 1. 85 (1):170-5. [Medline].

  34. Han L, Ho TF, Yip WC, Chan KY. Heart rate variability of children with mitral valve prolapse. J Electrocardiol. 2000 Jul. 33 (3):219-24. [Medline].

  35. Kochiadakis GE, Parthenakis FI, Zuridakis EG, Rombola AT, Chrysostomakis SI, Vardas PE. Is there increased sympathetic activity in patients with mitral valve prolapse?. Pacing Clin Electrophysiol. 1996 Nov. 19 (11 Pt 2):1872-6. [Medline].

  36. Altin C, Askin U, Gezmis E, Muderrisoglu H. Piezogenic pedal papules with mitral valve prolapse. Indian J Dermatol. 2016 Mar-Apr. 61 (2):234. [Medline].

  37. Ozkan M, Kaymaz C, Dinckal H, et al. Single-photon emission computed tomographic myocardial perfusion imaging in patients with mitral valve prolapse. Am J Cardiol. 2000 Feb 15. 85 (4):516-8, A11. [Medline].

  38. Cetinkaya M, Semizel E, Bostan O, Cil E. Risk of vasovagal syncope and cardiac arrhythmias in children with mitral valve prolapse. Acta Cardiol. 2008 Jun. 63 (3):395-8. [Medline].

  39. Demirol M, Karadeniz C, Ozdemir R, et al. Prolonged Tp-e Interval and Tp-e/QT Ratio in Children with Mitral Valve Prolapse. Pediatr Cardiol. 2016 Jun 1. [Medline].

  40. Guven B, Eroglu AG, Babaoglu K, et al. QT dispersion and diastolic functions in differential diagnosis of primary mitral valve prolapse and rheumatic mitral valve prolapse. Pediatr Cardiol. 2008 Mar. 29 (2):352-8. [Medline].

  41. Moradi M, Nazari M, Khajouei AS, Esfahani MA. Comparison of the accuracy of cardiac computed tomography angiography and transthoracic echocardiography in the diagnosis of mitral valve prolapse. Adv Biomed Res. 2015. 4:221. [Medline].

  42. Han Y, Peters DC, Salton CJ, et al. Cardiovascular magnetic resonance characterization of mitral valve prolapse. JACC Cardiovasc Imaging. 2008 May. 1 (3):294-303. [Medline].

  43. Hirata K, Pulerwitz T, Sciacca R, et al. Clinical utility of new real time three-dimensional transthoracic echocardiography in assessment of mitral valve prolapse. Echocardiography. 2008 May. 25 (5):482-8. [Medline].

  44. Beitnes JO, Klæboe LG, Karlsen JS, Urheim S. Mitral valve analysis using a novel 3D holographic display: a feasibility study of 3D ultrasound data converted to a holographic screen. Int J Cardiovasc Imaging. 2015 Feb. 31 (2):323-8. [Medline].

  45. Feuchtner GM, Alkadhi H, Karlo C, et al. Cardiac CT angiography for the diagnosis of mitral valve prolapse: comparison with echocardiography1. Radiology. 2010 Feb. 254 (2):374-83. [Medline].

  46. [Guideline] Salem DN, O'Gara PT, Madias C, Pauker SG, for the American College of Chest Physicians. Valvular and structural heart disease: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest. 2008 Jun. 133 (6 Suppl):593S-629S. [Medline].

  47. Karakurum B, Topcu S, Yildirim T, et al. Silent cerebral infarct in patients with mitral valve prolapse. Int J Neurosci. 2005 Nov. 115 (11):1527-37. [Medline].

  48. [Guideline] Gould FK, Elliott TS, Foweraker J, et al, for the Working Party of the British Society for Antimicrobial Chemotherapy. Guidelines for the prevention of endocarditis: report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother. 2006 Jun. 57 (6):1035-42. [Medline].

  49. Bobkowski W, Siwinska A, Zachwieja J, Mrozinski B, Rzeznik-Bieniaszewska A, Maciejewski J. A prospective study to determine the significance of ventricular late potentials in children with mitral valvar prolapse. Cardiol Young. 2002 Jul. 12 (4):333-8. [Medline].

  50. [Guideline] Bonow RO, Carabello B, de Leon AC, et al. ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease). J Heart Valve Dis. 1998 Nov. 7 (6):672-707. [Medline].

  51. 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. J Am Coll Cardiol. 2002 Oct 2. 40 (7):1298-304. [Medline].

  52. Gilon D, Buonanno FS, Joffe MM, et al. Lack of evidence of an association between mitral-valve prolapse and stroke in young patients. N Engl J Med. 1999 Jul 1. 341 (1):8-13. [Medline].

  53. Kitliński M, Stepniewski M, Nessler J, et al. Is magnesium deficit in lymphocytes a part of the mitral valve prolapse syndrome?. Magnes Res. 2004 Mar. 17 (1):39-45. [Medline].

  54. La Vecchia L, Ometto R, Centofante P, et al. Arrhythmic profile, ventricular function, and histomorphometric findings in patients with idiopathic ventricular tachycardia and mitral valve prolapse: clinical and prognostic evaluation. Clin Cardiol. 1998 Oct. 21 (10):731-5. [Medline].

  55. Leung DY, Dawson IG, Thomas JD, Marwick TH. Accuracy and cost-effectiveness of exercise echocardiography for detection of coronary artery disease in patients with mitral valve prolapse. Am Heart J. 1997 Dec. 134 (6):1052-7. [Medline].

  56. Perier P, Hohenberger W, Lakew F, Diegeler A. Prolapse of the posterior leaflet: resect or respect. Ann Cardiothorac Surg. 2015 May. 4 (3):273-7. [Medline].

  57. Song MG, Shin JK, Chee HK, Kim JS, Yang HS, Choi JB. Lifting posterior mitral annuloplasty for enhancing leaflet coaptation in mitral valve repair: midterm outcomes. Ann Cardiothorac Surg. 2015 May. 4 (3):249-56. [Medline].

  58. Delling FN, Rong J, Larson MG, et al. Familial clustering of mitral valve prolapse in the community. Circulation. 2015 Jan 20. 131 (3):263-8. [Medline].

  59. Motasaddi Zarandy M, Mahmoudi MJ, Malekzadeh I, Nasirmohtaram S. Frequency of congenital heart diseases in prelingual sensory-neural deaf children. Iran J Otorhinolaryngol. 2016 Mar. 28 (85):105-11. [Medline].

  60. Katan O, Michelena HI, Avierinos JF, et al. Incidence and predictors of infective endocarditis in mitral valve prolapse: a population-based study. Mayo Clin Proc. 2016 Mar. 91 (3):336-42. [Medline].

  61. Nordhues BD, Siontis KC, Scott CG, et al. Bileaflet mitral valve prolapse and risk of ventricular dysrhythmias and death. J Cardiovasc Electrophysiol. 2016 Apr. 27 (4):463-8. [Medline].

  62. Narayanan K, Uy-Evanado A, Teodorescu C, et al. Mitral valve prolapse and sudden cardiac arrest in the community. Heart Rhythm. 2016 Feb. 13 (2):498-503. [Medline].

  63. Kozanoglu E, Coskun Benlidayi I, Eker Akilli R, Tasal A. Is there any link between joint hypermobility and mitral valve prolapse in patients with fibromyalgia syndrome?. Clin Rheumatol. 2016 Apr. 35 (4):1041-4. [Medline].

 
Previous
Next
 
Mitral valve prolapse. A patient with straight back syndrome.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.