Mitral Valve Prolapse with Systemic Embolism: Report of Three Cases

Abstract

Mitral valve prolapse (MVP) is a common condition in the developed countries and apparently is the most frequently diagnosed valvular heart disease in the United States, with an overall prevalence of 5% and as high as 17% in young females.1 Several clinical studies have suggested that MVP is associated with certain serious complications such as progressive mitral regurgitation, bacterial endocarditis, arrhythmias, and sudden death. Moreover, cerebral and ophthalmic ischemic episodes, presumably secondary to embolism, have been reported recently as additional complications of MVP. [3][4][5][6][7][8][9][10][11][12][13] It is generally believed that rheumatic fever is still a major problem in the developing countries.14 Thus, it is assumed that the commonest form of valvular heart disease in these areas is rheumatic in origin. A recent study has shown that the prevalence rate for MVP in Saudi Arabia is comparable to that reported from the Western countries. 15There should be an awareness of its occurrence and possible complications in the developing countries.We, therefore, present case reports of three young Saudis with MVP complicated by cerebral and retinal embolism and review the relevant literature. Similar complications have been reported previously only from Canada, 3-5 England, 6 South Africa, 7 France, 8 and the United States, 9-13 but to our knowledge, these are the first cases reported from the Middle East and Asia of cerebral and retinal embolic phenomena associated with MVP. Case Reports Case 1A 16-year-old Saudi girl was referred to the University Hospital because of sudden blindness in the right eye which developed about 12 hours prior to presentation. There was no history of acute rheumatic fever, heart disease, dyspnea, chest pain, palpitations, dizziness, or previous visual symptoms. Ophthalmic examination revealed blindness of the right eye with only perception to light. Features of right central retinal artery occlusion were seen on funduscopy. Carotid pulses were normal, and there was no carotid artery bruit. She was afebrile, and the cardiac apex was in the normal location with no thrill or heaves. First and second heart sounds were normal. There was a grade 3/6 late systolic murmur at the apex, which was accentuated by hand grip. No click, gallop, or opening snap was heard. Results of all hematologic and biochemical investigations were normal. Blood culture showed no growths. Electrocardiograms and chest roentgenogram were normal. No arrhythmia was observed on a 24-hour Holter monitor recording. Echocardiogram showed holosystolic MVP with normal left atrial and left ventricular size. Case 2For a month prior to his referral, a 23-year-old Saudi man experienced recurrent attacks of blurred vision lasting a few minutes at a time. Four days before his visit to the University Hospital, he suddenly developed partial blindness in the mid-zone of the visual field of the left eye. At presentation, he denied any history of rheumatic fever, palpitation, dizziness, chest pain, or dyspnea. Ophthalmic eval...