Mitral valve repair is an effective treatment for ventricular arrhythmias in mitral valve prolapse syndrome

Abbadi, Deepika; Purbey, Rahul; Poornima, Indu

doi:10.1016/j.ijcard.2014.07.174

Cited by 27 publications

(19 citation statements)

References 10 publications

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“…Three years postoperatively the patient was disease-free. The case illustrates the need for high vigilance in the patients with malignant features of MVP, to prevent SCD and also a potential treatment option (33).…”

Section: Discussionmentioning

confidence: 97%

Mitral valve prolapse: an underestimated cause of sudden cardiac death—a current review of the literature

et al. 2017

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Mitral valve prolapse (MVP) is a common valve abnormality in general population. Despite the general belief of a benign disorder, several articles since the 1980s report sudden cardiac death (SCD) in MVP patients, with a substantial percentage of asymptomatic young individuals. The problem is to detect those patients at increased risk and implement methods that are suitable to prevent cardiac arrest. This review investigates the correlation between MVP and SCD, the understanding of the pathophysiology, the strategies for detecting those at risk and treatment options. A complete literature survey was performed using PubMed database search to gather available information regarding MVP and SCD. A total of 33 studies met selection criteria for inclusion in the review. MVP is an underrated cause of arrhythmic SCD. The subset of patients with malignant MVP who may be at greater risk for SCD is characterized by young women with bileaflet MVP, biphasic or inverted T waves in the inferior leads, and frequent complex ventricular ectopic activity with documented ventricular bigeminy or ventricular tachycardia (VT) and premature ventricular contractions (PVCs) configurations of outflow tract alternating with fascicular origin or papillary muscle. MVP is a common condition in the general population and is often encountered in asymptomatic individuals. The existing literature continues to generate significant controversy regarding the association of MVP with ventricular arrhythmias and SCD. Early echocardiography and cardiac magnetic resonance (CMR) are essential, as is a greater understanding of the potential electrophysiological processes of primary arrhythmogenesis and the evaluation of the genetic substrate.

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Section: Discussionmentioning

confidence: 97%

Mitral valve prolapse: an underestimated cause of sudden cardiac death—a current review of the literature

et al. 2017

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“…Vohra et al., described two MVP patients (ages 62 and 63 years), who underwent MV surgery in an effort to control ventricular tachycardia but continued to have inducible monomorphic VT after the surgery [6]. In contrast, other case series have reported successful VA reduction with surgical intervention [3], [4], [5]. It is noteworthy that these published cases of successful reduction in VE with surgery tended to be in younger patients (mean age 42.6 years), compared to those with refractory arrhythmias (mean age 62.5 years).…”

Section: Discussionmentioning

confidence: 99%

“…In isolated case reports, mitral valve surgery has been shown to reduce the burden of refractory ventricular arrhythmia [3], [4], [5]; however, not all MVP patients have a uniform reduction in arrhythmia burden after the surgery [6]. Moreover, MV surgery could potentially be pro-arrhythmic in some patients.…”

Section: Introductionmentioning

confidence: 99%

The effect of mitral valve surgery on ventricular arrhythmia in patients with bileaflet mitral valve prolapse

Naksuk

Syed

Krittanawong

et al. 2016

Indian Pacing and Electrophysiology Journal

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BackgroundBileaflet mitral valve prolapse (biMVP) is associated with frequent ventricular ectopy (VE) and malignant ventricular arrhythmia. We examined the effect of mitral valve (MV) surgery on VE burden in biMVP patients.MethodsWe included 32 consecutive patients undergoing MV surgery for mitral regurgitation secondary to biMVP between 1993 and 2012 at Mayo Clinic who had available pre- and post-operative Holter monitoring data. Characteristics of patients with a significant reduction in postoperative VE (group A, defined as >10% reduction in VE burden compared to baseline) were compared with the rest of study patients (group B).ResultsIn the overall cohort, VE burden was unchanged after the surgery (41 interquartile range [16, 196] pre-surgery vs. 40 interquartile range [5186] beats/hour [bph] post-surgery; P = 0.34). However, in 17 patients (53.1%), VE burden decreased by at least 10% after the surgery. These patients (group A) were younger than the group B (59 ± 15 vs. 68 ± 7 years; P = 0.04). Other characteristics including pre- and postoperative left ventricular function and size were similar in both groups. Age <60 years was associated with a reduction in postoperative VE (odds ratio 5.8; 95% confidence interval, 1.1–44.7; P = 0.03). Furthermore, there was a graded relationship between age and odds of VE reduction with surgery (odds ratio 1.9; 95% confidence interval 1.04–4.3 per 10-year; P = 0.04).ConclusionsMV surgery does not uniformly reduce VE burden in patients with biMVP. However, those patients who do have a reduction in VE burden are younger, perhaps suggesting that early surgical intervention could modify the underlying electrophysiologic substrate.

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“…Previous anecdotal reports suggested mitral repair as an effective measure to control arrhythmias [15,16]. Furthermore, a recent study including 8 patients with bileaflet MVP implanted with ICD due to ventricular malignant arrhythmia, revealed a significant reduction in malignant arrhythmia following surgical correction [17].…”

mentioning

confidence: 99%

Sudden Cardiac Death in Mitral Valve Prolapse: Are we ready for Risk Stratification?

M¹,

Wolak²

2017

JCCR

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Mitral valve repair is an effective treatment for ventricular arrhythmias in mitral valve prolapse syndrome

Cited by 27 publications

References 10 publications

Mitral valve prolapse: an underestimated cause of sudden cardiac death—a current review of the literature

Mitral valve prolapse: an underestimated cause of sudden cardiac death—a current review of the literature

The effect of mitral valve surgery on ventricular arrhythmia in patients with bileaflet mitral valve prolapse

Sudden Cardiac Death in Mitral Valve Prolapse: Are we ready for Risk Stratification?

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