Postinflammatory mitral and aortic valve prolapse: a clinical and pathological study.

Abstract

In this study we reevaluated whether the sole cause of mitral valve prolapse (MVP) and aortic valve prolapse (AVP) is myxomatous degeneration. Forty-two surgical cases of prolapsed valves with mitral and/or aortic regurgitation were reviewed (AVP in nine, MVP in 27, and combined AVP and MVP [CVP] MethodsForty-two consecutive surgical cases of regurgitant prolapsed valves and congestive heart failure at the University of Tokyo between 1978 and 1983 were reviewed. Twenty-five patients were men and 17 were women. Their ages ranged from 20 to 67 years (mean 43). Seven patients had a history suggestive of rheumatic fever. All patients had severe mitral (n = 27), aortic (n = 9), or combined mitral and aortic regurgitation (n = 6), and none had clinical valvular stenosis. The duration of symptoms ranged from 1 to 44 years (mean 12.8). The NYHA functional capacity was more than grade II in all patients. Atrial fibrillation was seen in 17 patients (63%) with mitral regurgitation, six (56%) with aortic regurgitation, and four (66%) with combined mitral and aortic regurgitation. This study did not include patients with atrial septal defect, ventricular septal defect, Marfan's syndrome, or other disease that may accompany mitral or aortic valve prolapse. The diagnosis of valve prolapse was made by two-dimensional echocardiographic and surgical findings.On two-dimensional echocardiography, mitral valve prolapse (MVP) was diagnosed when the mitral cusps protruded into the left atrium crossing the plane of the mitral anulus. During surgery, MVP was diagnosed by one surgeon when the intact valves protruded beyond the optimal position into the left atri-

Structural Basis for Mitral Valve Dysfunction Associated with Ostium Secundum Atrial Septal Defects

“…However, some patients with isolated mitral regurgitation or MV prolapse also have post-inflammatory lesions in the valve. This is not surprising since post-inflammatory MV prolapse has been recognised [12][13][14], Ab sence of excess mitral cuspal tissues, chordal redundancy and rupture differentiates postinflammatory MV prolapse from floppy mi tral valve syndrome. The presence of a past history of rheumatic fever in some of the patients with MV prolapse also suggests that at least in these patients MV prolapse could be a result of a chronic rheumatic process.…”

Chronic mitral regurgitation detected on cardiac MDCT: differentiation between functional and valvular aetiologies

“…The increased leaflet thickness in myxomatous valve leaflets can be explained by the increased thickness of the valvular spongiosa tissue that has been described from surgical series [20]. We identified leaflet calcification in four patients from the valvular group and one patient in the functional group.…”

“…Functional MR was diagnosed when (i) the leaflets appeared to be of normal length, with no evidence of thickening or calcification compared with controls, (ii) leaflet movement was restricted, (iii) myocardial wall motion abnormalities were detected and (iv) obstructive coronary artery disease was present [5,[19][20][21][22][23][24]. Valvular MR was diagnosed when (i) the leaflets were abnormally increased in length compared with controls, were thickened or calcified compared with controls, (ii) there was leaflet prolapse, (iii) the myocardium demonstrated normal global and regional wall motion and (iv) there were no obstructive coronary artery lesions (Table 1) [20,22,[24][25][26].…”

A Case of Acute Rheumatic Fever Accompanied by Transient Aortic Regurgitation.

“…It is possible that inflammation on the tips of the valves impaired coaptation and caused the valvular regurgitation. 13,18) Tomaru, et al 19) described that valvular regurgitations were caused by mitral and aortic valve prolapse. They postulated that myxomatous changes in those valves were caused by a postinflammatory process associated with chronic inflammation, including those after RF.…”