A Rare Case of Ischaemic Stroke in A Young Man with Mitral Valve Prolapse

Abstract

Mitral valve prolapse is a common valvular abnormality. It affects 2-3% of the general population. It often runs a benign course and the majority of patients are asymptomatic. Cardiac sources of thrombi account for about 20% of ischaemic strokes. There is lingering uncertainty regarding the causal link between mitral valve prolapse and ischaemic stroke. It has been suggested that changes on the surface of the valvular leaflets trigger platelet adherence and aggregation, leading to formation of platelet-fibrin thrombus which can embolize to the cerebral arteries, causing an ischaemic stroke. We herein report a case of a 25 year old young man who presented with sudden onset of left-sided weakness. Cardiac auscultation was notable for a late systolic murmur preceded by a midsystolic click at the apex. Transthoracic echocardiography showed an elongated and thickened anterior mitral valve leaflet which prolapsed into the left atrium during systole. Computed tomography scan of the brain revealed infarcts in the right frontal lobe and the right insular cortex. A diagnosis of myxomatous mitral valve prolapse complicated by ischaemic stroke was made and the patient was accordingly started on anticoagulant therapy with warfarin.

Stroke in mitral valve prolapse: risk factors and left atrial function in cryptogenic versus non-cryptogenic ischemic subtypes

“…We hypothesize that other causes of abnormal LA GLS such as hypertension and obesity, more prevalent in the stroke group, may have contributed to a decrease in LA GLS, hence “balancing out” values between the stroke and no stroke groups. Lower LA GLS has been shown to correlate with LA fibrosis in patients with and without mitral valve disease in histological studies ( 30 – 33 ). Although one small study describes LA strain patterns in MVP vs. rheumatic heart disease and suggests that peak atrial longitudinal strain (PALS) may be lower in rheumatic mitral valve disease compared to MVP ( 24 ), our study is the first to investigate the role of LA GLS (rather than PALS) in MVP and stroke.…”