Reversible mitral valve prolapse and mitral regurgitation in children with Graves' disease

An association between mitral valve prolapse (MVP) and hyperthyroidism has been described in adults. However, the long-term prognosis when associated with significant mitral regurgitation remains unclear. Three consecutive children with Graves' disease were found to have a loud mitral regurgitation murmur (grade III/VI) and echocardiographic evidence of MVP with moderate mitral regurgitation. The cardiac manifestations included palpitations, exertional dyspnea, and exercise intolerance. The electrocardiograms at presentation were sinus tachycardia in all cases. All had hyperthyroidism and positive thyroid antibodies. Exophthalmos occurred in two and appeared later than the cardiac symptoms in one. The cardiac murmur disappeared in all patients when antithyroid agents controlled the hyperthyroidism. Follow-up echocardiography showed normal in one and MVP with mild mitral regurgitation in two. We conclude that MVP and significant mitral regurgitation can occur in children with hyperthyroidism, especially those with Graves' disease. The prognosis is good after adequate medical control of the hyperthyroidism.     

Pectus excavatum in children : Diagnostic significance for mitral valve prolapse

Eighty-seven patients with pectus excavatum underwent cardiac examination and echocardiography (M-mode) to determine the diagnostic significance of pectus in children for mitral valve prolapse (MVP). Patients’ ages ranged from 1 month to 18 years with a mean age of 5.4 years. Sixty-seven were males. Twenty of the 87 pectus patients (23%) had echocardiographic evidence of MVP, whereas 11 of these had auscultatory findings of a non-ejection click or late systolic murmur, and 4 had significant mitral insufficiency. Fourteen of the 77 patients (18%) with mild pectus, and 6 of the 10 patients (60%) with severe pectus had MVP. Two of the patients (3.4%) with mild pectus and 2 of the patients (20%) with severe pectus also had significant mitral insufficiency. Ten of the 23 patients (44%) older than 8 years of age and 10 of the 64 younger patients (16%) had MVP. Although MVP was present more frequently in females (30%) than in males (21%), the difference was not statistically significant. This study indicates the high incidence of MVP in children of 8 years of age and older, especially when pectus deformity is severe. This information is particularly helpful to heighten suspicion of MVP in children with pectus excavatum.     

Childhood mitral valve prolapse

Mitral valve prolapse is now the most common cardiac diagnosis of childhood. The auscultatory findings of a non-ejection click with or without an associated murmur of mitral insufficiency are reviewed and related to the pathologic and histologic abnormalities. Findings at presentation in a large series of patients are given. Potential problems with progressive mitral insufficiency, arrhythmias and bacterial endocarditis are reviewed. This overview attempts to establish the essentially benign nature of mitral valve prolapse in childhood while indicating areas where continued observation is necessary.     

P-wave dispersion and heart rate variability in children with mitral valve prolapse

Previous studies have reported that patients with mitral valve prolapse (MVP) may display autonomic dysfunction. Measurement of heart rate variability (HRV) and P-wave dispersion (PWD) may provide insights into the functional state of the autonomic nervous system. Heart rate variability (HRV) has been used as a noninvasive marker of autonomic activity. However, to the authors?? knowledge, PWD has not been studied in the context of MVP. This study aimed to examine HRV and PWD in patients with MVP and to determine whether differences exist between symptomatic and asymptomatic patients. The study population consisted of 54 healthy children (17 boys and 37 girls) ages 6?C18?years and 76 patients with MVP (20 boys and 56 girls) ages 6?C18?years. The duration and dispersion of the P-wave were measured by surface 12-lead electrocardiograms (ECGs). Heart rate variability was quantified using both time-domain and frequency-domain analyses of Holter ECGs. The minimum duration of the P-wave was significantly lower in the MVP patients (42.4?±?10.0?ms) than in the control subjects (54.4?±?12.8?ms) (p?<?0.01), and the PWD was significantly increased in the MVP group (42.7?±?10.8?ms) compared with the control subjects (31.8?±?10.9?ms) (p?<?0.01). However, no significant differences were found between the symptomatic and asymptomatic patients. In addition, the HRV parameters were not statistically different between the two groups. In conclusion, although HRV parameters were not significantly different between the MVP and control groups, the findings show that PWD was increased for the children with MVP. However, no relationship could be established between PWD and clinical symptoms.     

Juvenile autoimmune thyroiditis and mitral valve prolapse

Summary An increased incidence of mitral valve prolapse (MVP) has been reported in adult patients with autoimmune thyroid disease. The aim of this study was to assess the incidence of MVP in children and adolescents with juvenile autoimmune thyroiditis (JAT). Cardiac echo studies using M-mode, 2D, and Doppler examinations were performed on 23 patients (21 females, 2 males). The patients were studied at a median age of 12 years (range 5–20 years). Only one patient was found to have evidence suggestive of MVP, an incidence (4.3%) similar to that seen in the normal pediatric population. We, therefore, conclude that the incidence of MVP in children and adolescence with JAT is not increased.     

Ventricular arrhythmias and mitral valve prolapse in childhood

Although ventricular arrhythmias are well described in adults with mitral valve prolapse, this association remains controversial in children. To assess the incidence of ventricular premature complexes (VPCs), 103 consecutive children with mitral valve (MV) prolapse confirmed by echocardiography were evaluated prospectively by treadmill exercise and ambulatory ECG. A group of 50 normal children with clinical, ECG, or echocardiographic evidence of heart disease who had undergone treadmill exercise and ambulatory ECG served as controls. In the group with MV prolapse, 16 patients had VPCs with treadmill exercise and 39 had VPCs on ambulatory ECG. High-grade ventricular ectopy (multiform VPCs, couplets, or ventricular tachycardia) was recorded in four patients with MV prolapse during treadmill exercise and in eight during ambulatory ECG. In contrast, no control patient had a single VPC in response to treadmill exercise and only four control patients had rare uniform VPCs on ambulatory ECG. Neither physical examination findings, standard ECG results, nor symptoms could be correlated with VPCs in the patients with MV prolapse. Although the prognostic implications of these findings are uncertain, this study demonstrates that potentially serious ventricular arrhythmias are frequently observed in children with MV prolapse.     

Mitral valve prolapse: associations with symptoms and anxiety

Mitral valve prolapse has been studied extensively in the adult population, but less is known about it in children. Therefore, 813 children between 9 and 14 years of age were examined by a team of cardiologists and technicians. The children also responded to a questionnaire concerning the presence of symptoms and the What I Think and Feel anxiety instrument. The prevalence of mitral valve prolapse using auscultatory criteria was 4.2% (6.2% for girls, 2.3% for boys). Of those with mitral valve prolapse, 85% had a solitary click, 9% had a click and systolic murmur, and 6% had multiple clicks. Children with auscultatory mitral valve prolapse were less likely to have symptoms than those free of cardiac abnormalities. No difference in average anxiety scores was detected between the two groups. It is concluded that auscultatory mitral valve prolapse is common in children and not accompanied by an increased likelihood of symptoms or anxiety.     

Angiographic quantification of mitral valve prolapse in children with secundum atrial septal defect

Summary We devised a simple method for quantifying mitral valve prolapse (MVP), relating the furthest point of prolapse to the measured length of the mitral orifice. By means of this index (MVPI), MVP was diagnosed angiographically in 10 of the 60 children with atrial septal defect (ASD). The mean age of the 10 children was 4.7 years. Cineangiography near the 60° right anterior oblique projection gave a profile of the mitral valve suitable for both qualitative and quantitative assessment. So far, MVP seems to be a relatively benign complication in this group of 10 children with ASD. Supported in part by Ontario Heart Foundation Grant #t-4-2 (1975–78).     

Echocardiographic study of the heart in children with mitral valve prolapse and connective tissue dysplasia

Altogether 125 children with connective tissue dysplasia and mitral valve prolapse were subjected to clinical and echographic examinations. Dilation of the aortic root, elevation of pulmonary artery pressure and derangement of myocardial contractility were discovered. These disorders occurred as a result of disseminated connective tissue abnormalities. It is noted that children with connective tissue dysplasia and mitral valve prolapse require prophylactic medical examination because of progressive alterations on the part of the cardiovascular system with age.     

A clinical profile of mitral valve prolapse syndrome

Clinical, radiologic, electrocardiographs and 2-dimensional echocardiographic findings of fifty cases of mitral valve prolapse syndrome attending the Pediatric Cardiology clinic of I.C.H. and Childrens Hospital, Medical College, Kottayam over a period of ten years from 1980-1989 are presented. Mitral valve prolapse syndrome (MVPS) accounted for 2% of cardiac problems attending our pediatric cardiology clinic. Isolated MVPS constituted 64% of the cases. The common causes of secondary MVPS were Marfan Syndrome-18%, Atrial Septal Defect-10% and Rheumatic fever-8%. Associations of MVPS included Pectus excavatum (8%), Isolated arachnodactyly (2%) and Straight back syndrome (2%). 2-D echocardiogram demonstrated prolapse of both leaflets of Mitral valve in 44%, Isolated posterior mitral valve leaflet prolapse in 32% and Isolated anterior mitral valve leaflet prolapse in 24% of cases. No complications were seen during follow up.     

Association of hiatal hernia with mitral valve prolapse

Cardiological investigation of 23 children (13 boys) with sliding hiatal hernia revealed mitral valve prolapse in 18 patients (10 boys) suggesting a very high association rate of 78.2%. No other signs of connective tissue weakness were seen. Conclusion Cardiological evaluation is recommended in every child with hiatal hernia. Received: 19 January 1996 / Accepted: 25 May 1996     

Association of hiatal hernia with mitral valve prolapse

Cardiological investigation of 23 children (13 boys) with sliding hiatal hernia revealed mitral valve prolapse in 18 patients (10 boys) suggesting a very high association rate of 78.2%. No other signs of connective tissue weakness were seen. Conclusion Cardiological evaluation is recommended in every child with hiatal hernia.     

Mitral valve prolapse and body habitus in children

Summary Mitral valve prolapse has generally been associated in adults with a thin body habitus. However, prior studies used biased samples or limited anthropometric measures. In addition, no information has been available on the subjective assessment of body habitus and diagnosis of mitral valve prolapse, especially in children.We conducted a cross-sectional study on 813 children with uniform assessment of anthropometric measures and mitral valve prolapse.Consistent with research conducted on adults, those subjects with mitral valve prolapse were lighter, thinner, and had, on average, lower values for several, quantifiable anthropometric parameters with the exception of height. However, the subjective assessment showed that while the assessment did not differ by diagnosis, those subjects with mitral valve prolapse were never described as fat.These data support an association between mitral valve prolapse and slender body habitus and extends it to children, thus underscoring the clinical importance that a thin body habitus may be a marker for mitral valve prolapse throughout the age span. This association may partly explain the observed genetic distribution of mitral valve prolapse.