Mitral Valve Prolapse: An Assessment of Clinical Features, Associated Conditions and Prognosis

One hundred and eighty-two patients (100 females, 82 males)with mitral valve prolapse (MVP) confirmed by echocardiographyare described. Their ages range from 12 to 87 years (mean 48years). The symptoms of breathlessness, pain in the chest andpalpitations were analysed. They were associated with left ventricularfailure, co-existing ischaemic heart disease and arrhythmiasin some, but in a proportion the symptoms were thought to bedue to psychoneurosis. Seventy-two patients (40 per cent) werereferred because of complications of MVP. In 67 patients (37per cent) the condition was discovered by chance and in 43 patients(24 per cent) neurotic symptoms had led to referral to hospital.A systolic click was heard in 117 patients (54 per cent); 41patients (23 per cent) had a late systolic murmur and 30 patients(16 per cent) had a pansystolic murmur. The incidence of murmursrose with increasing age, and pansystolic murmurs were morefrequent in males. Thirty-two patients (18 per cent) had neithera click nor a murmur. Twenty-four patients (13 per cent) hadassociated supraventricular tachycardia and 22 (12 per cent)atrial fibrillation. Twelve patients (7 per cent) had severemitral incompetence and eight (4 per cent) developed bacterialendocarditis. Only three patients had symptoms suggesting cerebralischaemia. Twelve patients (7 per cent) had associated aorticincompetence. Twenty-two patients had had an inguinal hernia,the incidence in males over 50 being 26 per cent. Twenty-sixpatients (14 per cent) had non-specific T wave changes in theelectrocardiogram. Echocardiography showed that 112 patients(62 per cent) had mid-systolic buckling of the posterior leafletand 70 patients (38 per cent) had holosystolic prolapse. Inview of the high incidence of complications it is felt thatthe long-term prognosis not as good as has been generally believed.