Low ability of blood lymphocytes to produce interferon-gamma in patients with idiopathic prolapse of mitral valve

AIM: To examine lymphocyte ability to synthetize interferon-gamma in patients with mitral prolapse (MP). MATERIAL AND METHODS: The diagnosis of MP was made in 75 patients at echocardiography. ECG monitoring was made and the study of the ability of blood lymphocytes to produce IFN-gamma (If-g). RESULTS: The ability to produce If-g was diminished. This phenomenon is associated with chronic inflammation, autonomic disregulation of cardiac activity, depends on gender. CONCLUSION: Cytokine modulates metabolism of connective tissue in MP so If-g may participate in MP pathogenesis. Therefore, If-g and/or its inductors may prevent some MP-related complications due to its deficiency.     

The treatment of mitral valve prolapse syndrome in a nurse-managed outpatient mitral valve prolapse clinic

Symptoms of mitral valve prolapse syndrome, the most common valvular disorder, include anxiety, fatigue, palpitations, headaches, and chest pain, to name a few. This syndrome is effectively treated in a nurse-managed, outpatient clinic that specializes in the treatment of mitral valve prolapse syndrome.     

Predictors of ventricular arrhythmias in patients with mitral valve prolapse

Arrhythmias have been reported to occur frequently in symptomatic patients with mitral valve prolapse (MVP). The mechanisms causing ventricular arrhythmias in patients with MVP have not been fully investigated. The purpose of this study was to determine the clinical, echocardiographic and heart rate variability parameters, and plasma concentrations of electrolytes and inflammatory markers in predicting ventricular arrhythmias in patients with MVP. A total of 58 consecutive patients with MVP were included in this study. We performed electrocardiography, echocardiography, holter analysis, routine biochemical tests including plasma concentrations of electrolytes and inflammatory markers, and evaluated the clinical characteristics. Ventricular arrhythmia defined as occurrence of any of the followings: ventricular premature contractions (VPCs), VPC couplets, and ventricular tachycardia documented by holter analysis, continuous monitoring or by electrocardiography. Twenty patients (34%) had ventricular arrhythmias, and 38 (66%) patients had no ventricular arrhythmias. Seventeen patients had VPC, 2 patients had VPC couplets and 1 patient had ventricular tachycardia. Univariable predictors of ventricular arrhythmias included isovolumetric relaxation time and the occurrence of moderate to severe mitral regurgitation. Multivariable logistic regression analysis showed that occurrence of moderate to severe mitral regurgitation was the only independent predictor of ventricular arrhythmias (relative risk: 8.42, 95% confidence interval: 1.49–47.64, p = 0.01). Present study showed that the only independent predictor of ventricular arrhythmias in patients with MVP is the occurrence of moderate to severe mitral regurgitation.     

Follow-up of patients with mitral valve prolapse presenting with rhythm disturbances

The aim of the study was to analyze rhythm disturbances and clinical course in 18 patients aged 20-52 years with mitral valve prolapse. The patients were followed up for a mean of three years (range: 1-11 years). We analyzed clinical signs, resting ECG 24 hour ECG, exercise ECG, echocardiograms and the effects of antiarrhythmic treatment. One patient developed marked mitral incompetence. Supraventricular arrhythmias occurred in three patients and ventricular extrasystoles in all 18 patients (class I in 2, II in 6, III in 4, IV in 3, V in 3, according to Lown). Five patients required combined antiarrhythmic treatment. Course of pregnancy and births in two patients with mitral valve prolapse syndrome and class IV arrhythmias were uncomplicated for both the mothers and their babies. Great clinical variability of mitral valve prolapse syndrome ranging from an asymptomatic form to ventricular fibrillation is emphasized.     

Echocardiographically determined mitral valve prolapse in male patients

Mitral valve prolapse syndrome is a common clinical entity that may occur as an isolated condition or in association with other cardiovascular diseases. In this retrospective study, 41% (23/56) of the male patients with echocardiographically diagnosed mitral valve prolapse had an additional form of cardiovascular disease.     

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

To characterize the spectrum of mitral regurgitation in mitral valve prolapse, one hundred patients were studied by color Doppler flow mapping. The findings were correlated with the clinical presentation and with the possible complications. Mitral regurgitation was absent in 46 patients, mild in 26 patients, moderate in 18 patients and severe in 10 patients. The jet orientation was central in 15 patients, antero-medial in 13 patients and postero-lateral in 26 patients. The regurgitation was early systolic in 7 patients, late systolic in 20 patients and holosystolic in 27 patients. A good agreement was observed between the color flow patterns and the presence, timing and radiation of a murmur. Systolic clicks were not predictors of the presence or the severity of regurgitation. The grade of mitral regurgitation was positively correlated with age, left heart enlargement and valvular redundancy. No sex difference was observed. The prevalence of serious arrhythmias or cerebral ischemic events was not significantly increased when a regurgitation was present.     

Pain in mitral valve prolapse

Thirty subjects with mitral valve prolapse were carefully observed, in order to investigate whether chest pain, characteristic of angina pectoris, was present. No cases of angina pectoris or of heart pain were observed. A characteristic which did emerge was that 86% of the subjects suffered a typical myofascial pain of the muscles of the chest. There does not appear to be a clear relationship between mitral valve prolapse and myofascial pain.     

Current management of mitral valve prolapse

Mitral valve prolapse is a pathologic anatomic and physiologic abnormality of the mitral valve apparatus affecting mitral leaflet motion. "Mitral valve prolapse syndrome" is a term often used to describe a constellation of mitral valve prolapse and associated symptoms or other physical abnormalities such as autonomic dysfunction, palpitations and pectus excavatum. The importance of recognizing that mitral valve prolapse may occur as an isolated disorder or with other coincident findings has led to the use of both terms. Mitral valve prolapse syndrome, which occurs in 3 to 6 percent of Americans, is caused by a systolic billowing of one or both mitral leaflets into the left atrium, with or without mitral regurgitation. It is often discovered during routine cardiac auscultation or when echocardiography is performed for another reason. Most patients with mitral valve prolapse are asymptomatic. Those who have symptoms commonly report chest discomfort, anxiety, fatigue and dyspnea, but whether these are actually due to mitral valve prolapse is not certain. The principal physical finding is a midsystolic click, which frequently is followed by a late systolic murmur. Although echocardiography is the most useful mode for identifying mitral valve prolapse, it is not recommended as a screening tool for mitral valve prolapse in patients who have no systolic click or murmur on careful auscultation. Mitral valve prolapse has a benign prognosis and a complication rate of 2 percent per year. The progression of mitral regurgitation may cause dilation of the left-sided heart chambers. Infective endocarditis is a potential complication. Patients with mitral valve prolapse syndrome who have murmurs and/or thickened redundant leaflets seen on echocardiography should receive antibiotic prophylaxis against endocarditis.     

Middiastolic click in mitral valve prolapse

The interesting and unusual occurrence of a middiastolic click is documented in an asymptomatic young woman with typical mitral valve prolapse. This click is shown to occur later in diastole than previously reported diastolic clicks in this syndrome.     

Marfan syndrome and mitral valve prolapse

Mitral valve prolapse (MVP), an abnormal displacement into the left atrium of a thickened and redundant mitral valve during systole, is a relatively frequent abnormality in humans and may be associated with serious complications. A recent study implicates fibrillin-1, a component of extracellular matrix microfibrils, in the pathogenesis of a murine model of MVP. This investigation represents an initial step toward understanding the mechanisms involved in human MVP disease and the development of potential treatments.     

Sudden death in mitral valve prolapse

The authors describe a case of sudden death (SD) of a patient with unaltered coronary arteries, myxomatous degeneration and mitral valve prolapse (MVP). The case was marked by an isolated prolapse of the anterior cusp of the mitral valve because of its congenital structural abnormalities, which was not encountered previously in MVP patients who died suddenly. Microscopic examination showed large-focal cardiosclerosis at the basis of the papillary muscles determined by dysfunction of the mitral apparatus which might be related to the pathogenesis of lethal arrhythmia. It is believed that MVP patients should constitute a separate group with high risk of SD.     

Dynamics of cardiovascular system functional state indices in patients with idiopathic mitral valve prolapse against the background of magnerot and alprazolam therapy

144 patients with idiopathic mitral valve prolapse (MVP) were examined. They were divided into groups of treatment with magnerot, and placebo (control group). Decrease of echocardiography indices of MVP was noticed in the patients who received magnerot. After therapy with alprazolam only tendency to decrease of prolapse depth was registered. Significant decrease of maximal systolic and diastolic pressure, mean diastolic pressure, hypertonic load with diastolic pressure and increased variability of systolic and diastolic pressure occurred after therapy with magnerot. Decrease of systolic and diastolic pressure was noticed after therapy with alprazolam. At Halter monitoring of patients with MVP were noticed that magnerot had greater effect than alprazolam to decrease of number of tachycardia (paroxysmal supraventricual and nonparoxysmal) episodes. Significant decrease of number of patients with sympathicotonia and, at the same time, increase of number of person with equal tonus of both vegetative nervous systems were registered after therapy with magnerot (by 9 times) and with alprazolam (by 4.5 times).     

The impact of echocardiographic results on treatment decisions for patients suspected of mitral valve prolapse

Although echocardiography is frequently ordered in ambulatory settings for patients suspected of mitral valve prolapse (MVP), its impact on their subsequent management is unknown. We studied the relationship between the results of echocardiography for outpatients suspected of MVP, and two frequent medical decisions: treatment with beta blockers and the recommendation of antibiotic prophylaxis to prevent bacterial endocarditis. A medical record audit was performed on 274 outpatients referred to a university medical center echocardiography laboratory to rule out MVP. Although echocardiographic evidence for MVP significantly influenced the decision to recommend antibiotic prophylaxis (P less than 0.001), symptoms were more likely to be used as indications for beta-blocker therapy in patients suspected of the condition. We conclude that echocardiographic results are used for recommending antibiotic prophylaxis to outpatients suspected of MVP, but not for beta-blocker therapy.     

The hemodynamic support of physical loading in patients with mitral valve prolapse]

Bicycle ergometry and echocardiographic studies were carried out in 29 patients aged 17-29 years with first revealed mitral valve prolapse (MVP) without any signs of mitral regurgitation. According to bicycle ergometry, the patients manifested changes in hemodynamics pointing to dysfunction of the cardiovascular system. Echocardiography discovered a reduction of the mass and a rise of the rate of contraction of the circular fibers of the left ventricle, evidence of the myocardial genesis of the hemodynamic changes. Comparison of the findings of bicycle ergometry and echocardiography allowed a conclusion about the necessity of the follow-up of patients with MVP in spite of the high level of threshold load and the lack of the clinical signs of heart failure.     

An overview of mitral valve prolapse.

Mitral valve prolapse is a commonly diagnosed condition involving the cardiac valves. Although usually a benign disorder, there may be complications that require hospitalization in a critical care unit. This article provides an overview of mitral valve prolapse--pathophysiology, signs and symptoms, medical management, potential complications, and nursing management.