Lifetime risk for patients with mitral valve prolapse of developing severe valve regurgitation requiring surgery.

Abstract

Severe mitral regurgitation requiring surgery is the most common life-threatening complication of mitral valve prolapse (MVP) , and 1:28 (22-41), respectively. In women, the risk was less than half that in men (p<0.001). We conclude that the risk of developing severe mitral regurgitation is age and sex related, is minimal before the age of 50, and rises sharply after the age of 50, particularly in men, and that the current minimum number of patients requiring myxomatous mitral valve surgery in Australia is between 150 and 200 per year, a caseload that will increase with the advancing age of the population. The findings are consistent with the predictions of a response-to-injury hypothesis that explains the pathogenesis of progressive changes in the prolapsing mitral valve. (Circulation 1988;78:10-14) P rimary mitral valve prolapse, as opposed to that secondary to a systemic disorder of connective tissue or to a reduction in left ventricular cavity size, occurs with a prevalence of 2.5-5% in the adult population, according to recent surveys using careful clinical and echocardiographic diagnostic criteria. [1][2][3][4] It is relatively uncommon before the growth spurt of adolescence,5,6 but thereafter, the prevalence in men remains relatively constant. Most studies have found a greater prevalence in women than in men, and among women, there are data suggesting a greater prevalence in adolescence and young adulthood. 1,4 (However,

The spectrum of mitral regurgitation in idiopathic mitral valve prolapse: a Color Doppler study

“…However a male preponderance was present in patients with severe regurgitation. This is in agreement with the increased risk of serious mitral regurgitation in male patients over 50 years of age [29][30][31][32].…”

“…As previously reported, the prevalence and the severity of mitral regurgitation increased with age, reflecting the degenerative character of the valvular affection [3,17,[29][30][31][32][33]. In counterpart, the average severity score was not different in men and women.…”

Marfan syndrome and mitral valve prolapse

“…The most common complication of MVP is severe regurgitation due to progressive degeneration of the valve and chordae, with myxomatous infiltration (thickening of the mitral layers with glycosaminoglycan accumulation), and fibroelastic and collagen alterations (10,11,13). In about 75% of cases, there is sudden deterioration because of chordal rupture (14).…”

“…The cumulative risk of severe mitral regurgitation and valve rupture is minimal in individuals younger than 50 years of age but then rises steeply, with the risk in men being greater than in women beyond the age of 60. Using current prevalence data, it can be estimated that by the age of 70, approximately 11% of men and 6% of women with classic MVP will need mitral valve replacement (13).…”

“…In the recent study of the offspring cohort of the Framingham Heart Study (10), the incidence of MVP did not differ between the sexes, and no predisposition to prolapse was observed in younger or older adult subjects; this was supported by an even distribution (2-3%) among subjects in each decade from 30 to 80 years. Other data regarding the prevalence of MVP in children suggest that prolapse is uncommon before adolescence, but its prevalence increases after the adolescent growth spurt (12,13). Nonclassic prolapse appears morphologically to be an intermediate stage between normal mitral valve anatomy and classic prolapse, but studies with up to a 10-year follow-up have shown no evidence of progression from one form to another, and the Framingham Heart Study failed to show an age-related shift from one type to the other, although the patient numbers studied in each age group were small.…”