Hostname: page-component-7b7567c8c-wxvwp Total loading time: 0 Render date: 2026-11-15T15:05:44.828Z Has data issue: false hasContentIssue false
  • English
  • Français

Mitral valve prolapse and left ventricular systolic function

Published online by Cambridge University Press:  06 March 2015

Eduard Malev and
Eduard Zemtsovsky
Eduard Malev
Affiliation:
Department of Connective Tissue Disorders, Federal North-West Medical Research Centre, Saint-Petersburg, Russia
Eduard Zemtsovsky
Affiliation:
Department of Propaedeutic of Internal Diseases, State Pediatric Medical University, Saint-Petersburg, Russia
Rights & Permissions [Opens in a new window]

Abstract

An abstract is not available for this content. As you have access to this content, full HTML content is provided on this page. A PDF of this content is also available in through the ‘Save PDF’ action button.

Information

Type
Letters to the Editor
Information
Cardiology in the Young , Volume 25 , Issue 6 , August 2015, pp. 1232
Check for updates
Copyright
© Cambridge University Press 2015 

We thank Dr Yiğiner et alReference Yiğiner, Degirmencioglu, Doğan and Sitki Cebeci 1 for their interest in our study regarding the left ventricular function in young adults with mitral valve prolapse without significant mitral regurgitation.Reference Malev, Reeva and Vasina 2 Their commentary emphasised the importance of the aetiological distinction of mitral valve prolapse for medium- and long-term prognosis and reconstructive surgery timing decision.

Indeed, myxomatous Barlow’s disease – syn.: classic mitral valve prolapse – and fibroelastic deficiency are the two dominant forms of degenerative mitral valve disease, and have unique differentiating characteristics on clinical and echocardiographic assessment.Reference Anyanwu and Adams 3 In our study, myxomatous changes in mitral leaflets were identified only by transthoracic echocardiography and have not been confirmed by histological examinations. At present, despite the introduction of three-dimensional trans-oesophageal echocardiography in routine practice, transthoracic echocardiography is the optimal non-invasive technique to determine the morphology and to identify aetiologies of mitral valve prolapse compared with surgical and pathological findings.Reference Malev, Kim, Mitrofanova and Zemtsovsky 4

Some previous pathology studies in myxomatous mitral valve prolapse provided evidences for intramyocardial extracellular matrix changes as a specific reflection of a general myxomatous alteration in cardiac connective tissue.Reference Morales, Romanelli and Boucek 5 , Reference Dollar and Roberts 6 These changes may cause both left ventricular enlargement and systolic dysfunction in classical mitral valve prolapse.

The low longitudinal deformation in septal segments revealed in our study is only the first sign of future deterioration of the left ventricular systolic function by mitral valve prolapse progression. The significantly worse contractile function of the septum compared with other left ventricular regions was demonstrated by MRI-based strain analysis in patients with mitral valve prolapse and moderate-to-severe chronic mitral regurgitation.Reference Maniar, Brady and Lee 7 In patients with severe chronic mitral regurgitation, we found significant decrease of the global longitudinal systolic strain in myxomatous Barlow’s disease compared with fibroelastic deficiency.Reference Malev, Kim, Mitrofanova and Zemtsovsky 4 Importantly, the subclinical regional and global left ventricular systolic dysfunction in mitral valve prolapse were not revealed by conventional echocardiography and required a novel echocardiography-based or MRI-based strain technique.

Myxomatous Barlow’s disease leads to the anterior or bileaflet prolapse, requires a more complex type of repair, and greater surgical expertise. Lower pre-operative left ventricular systolic function in myxomatous mitral valve prolapse may demand the earlier repair procedure for severe mitral regurgitation and affect the post-operative medium- and long-term survival.

Thus, left ventricular dysfunction is an integral part of myxomatous mitral valve disease, and may affect even young patients without significant mitral regurgitation and influence their long-term prognosis.

Eduard Malev

Department of Connective Tissue Disorders, Federal North-West Medical Research Centre, Saint-Petersburg, Russia

Eduard Zemtsovsky

Department of Propaedeutic of Internal Diseases, State Pediatric Medical University, Saint-Petersburg, Russia

References

1. Yiğiner, O, Degirmencioglu, G, Doğan, M, Sitki Cebeci, B. Mitral regurgitation: many reasons, multiple myocardial conditions and several surgical options. Cardiol Young 2015.Google ScholarPubMed
2. Malev, E, Reeva, S, Vasina, L, et al. Cardiomyopathy in young adults with classic mitral valve prolapse. Cardiol Young 2014; 24: 694–701.Google Scholar
3. Anyanwu, AC, Adams, DH. Etiologic classification of degenerative mitral valve disease: Barlow’s disease and fibroelastic deficiency. Semin Thorac Cardiovasc Surg 2007; 19: 90–96.CrossRefGoogle ScholarPubMed
4. Malev, E, Kim, G, Mitrofanova, L, Zemtsovsky, E. Preoperative left ventricular function in degenerative mitral valve disease. J Cardiovasc Med (Hagerstown) 2014; 15: 222–229.Google Scholar
5. Morales, AR, Romanelli, R, Boucek, RJ, et al. Myxoid heart disease: an assessment of extravalvular cardiac pathology in severe mitral valve prolapse. Hum Pathol 1992; 23: 129–137.Google Scholar
6. Dollar, AL, Roberts, WC. Morphologic comparison of patients with mitral valve prolapse who died suddenly with patients who died from severe valvular dysfunction or other conditions. J Am Coll Cardiol 1991; 17: 921–931.Google Scholar
7. Maniar, H, Brady, B, Lee, U, et al. Early left ventricular regional contractile impairment in chronic mitral regurgitation occurs in a consistent, heterogeneous pattern. J Thorac Cardiovasc Surg 2014; 148: 1694–1699.Google Scholar