Cerebral ischemic events in patients with mitral valve prolapse.

Sandok, Burton A.; Giuliani, Emilio R.

doi:10.1161/01.str.13.4.448

Cited by 45 publications

(20 citation statements)

References 30 publications

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“…Similar complications have been reported previously only from Canada, [3][4][5] England, 6 South Africa, 7 France, 8 and the United States, [9][10][11][12][13] but to our knowledge, these are the first cases reported from the Middle East and Asia of cerebral and retinal embolic phenomena associated with MVP.…”

supporting

confidence: 86%

“…3 On the other hand, the earliest report of retinal vascular lesions in MVP was presented by Woldoff et al 11 Since then, there have been numerous communications suggesting a causal relationship between MVP and ischemia of the eye and brain. [3][4][5][6][7][8][9][10][11][12][13] None of our three patients with MVP suffered from hypertension, diabetes mellitus, rheumatic heart disease, vasculitis, hematologic disorders, or any other predisposing factor for strokes. Therefore, it is very likely that the ischemic attacks in these young Saudis were due to thrombotic emboli originating in a prolapsed mitral valve.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, cerebral and ophthalmic ischemic episodes, presumably secondary to embolism, have been reported recently as additional complications of MVP. [3][4][5][6][7][8][9][10][11][12][13] It is generally believed that rheumatic fever is still a major problem in the developing countries.…”

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Mitral Valve Prolapse with Systemic Embolism: Report of Three Cases

et al. 1989

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Mitral valve prolapse (MVP) is a common condition in the developed countries and apparently is the most frequently diagnosed valvular heart disease in the United States, with an overall prevalence of 5% and as high as 17% in young females.1 Several clinical studies have suggested that MVP is associated with certain serious complications such as progressive mitral regurgitation, bacterial endocarditis, arrhythmias, and sudden death. Moreover, cerebral and ophthalmic ischemic episodes, presumably secondary to embolism, have been reported recently as additional complications of MVP. [3][4][5][6][7][8][9][10][11][12][13] It is generally believed that rheumatic fever is still a major problem in the developing countries.14 Thus, it is assumed that the commonest form of valvular heart disease in these areas is rheumatic in origin. A recent study has shown that the prevalence rate for MVP in Saudi Arabia is comparable to that reported from the Western countries. 15There should be an awareness of its occurrence and possible complications in the developing countries.We, therefore, present case reports of three young Saudis with MVP complicated by cerebral and retinal embolism and review the relevant literature. Similar complications have been reported previously only from Canada, 3-5 England, 6 South Africa, 7 France, 8 and the United States, 9-13 but to our knowledge, these are the first cases reported from the Middle East and Asia of cerebral and retinal embolic phenomena associated with MVP. Case Reports Case 1A 16-year-old Saudi girl was referred to the University Hospital because of sudden blindness in the right eye which developed about 12 hours prior to presentation. There was no history of acute rheumatic fever, heart disease, dyspnea, chest pain, palpitations, dizziness, or previous visual symptoms. Ophthalmic examination revealed blindness of the right eye with only perception to light. Features of right central retinal artery occlusion were seen on funduscopy. Carotid pulses were normal, and there was no carotid artery bruit. She was afebrile, and the cardiac apex was in the normal location with no thrill or heaves. First and second heart sounds were normal. There was a grade 3/6 late systolic murmur at the apex, which was accentuated by hand grip. No click, gallop, or opening snap was heard. Results of all hematologic and biochemical investigations were normal. Blood culture showed no growths. Electrocardiograms and chest roentgenogram were normal. No arrhythmia was observed on a 24-hour Holter monitor recording. Echocardiogram showed holosystolic MVP with normal left atrial and left ventricular size. Case 2For a month prior to his referral, a 23-year-old Saudi man experienced recurrent attacks of blurred vision lasting a few minutes at a time. Four days before his visit to the University Hospital, he suddenly developed partial blindness in the mid-zone of the visual field of the left eye. At presentation, he denied any history of rheumatic fever, palpitation, dizziness, chest pain, or dyspnea. Ophthalmic eval...

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confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Mitral Valve Prolapse with Systemic Embolism: Report of Three Cases

et al. 1989

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“…25 Also, CI in association with MVP may be related to platelet hyperaggregability. 26 " 28 Thus, it is not unexpected that Sandok and Giuliani 29 reported that the prevalence rate for stroke in persons with MVP was four times greater than that for the normal population.…”

Section: Discussionmentioning

confidence: 96%

Cerebral ischemia and mitral valve prolapse: case-control study of associated factors.

Kelley

Piña

Lee

1988

Stroke

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We evaluated 36 patients with cerebral ischemia and mitral valve prolapse and compared them with 36 age-matched controls with cerebral ischemia who had similar attributes but who did not have mitral valve prolapse. Stepwise logistic regression analysis revealed an inverse relation between cerebral ischemia in the presence of mitral valve prolapse and hypertension, diabetes mellitus, occlusive cerebrovascular disease, and completed stroke at p<0.01. We also found, by correlation analysis, a negative correlation between both hypertension and diabetes mellitus versus mitral valve prolapse at p<0.05. Overall, 10 study patients compared with two control patients had no risk factors for cerebrovascular disease detected (x 2 = 4.9, p<0.05). These data indicate that the association of mitral valve prolapse and cerebral ischemia is of special importance in patients who do not have other detected risk factors for cerebrovascular disease. (Stroke 1988; 19:443-446) T here continues to be considerable controversy about the exact role of mitral valve prolapse (MVP) in cerebral ischemia (CI). The numerous reports suggesting an association 1 " 4 have been influenced by patient selection and possible referral bias. One would expect, for example, that with a 2.5-7% prevalence of MVP in the general population 5 " 7 a significantly higher percentage of patients in prospective stroke series would be detected with MVP. This has not been found to be the case. In one large stroke series, 8 no patient with MVP was detected despite 55% of those with presumptive cerebral embolus having echocardiography performed. In a recent series of 144 young patients with ischemic stroke, 9 eight patients (5.6%) had MVP, and only three of these eight were believed to have MVP as the primary etiologic factor after intensive investigation. This has led to speculation that, although MVP has the potential to promote cerebral embolus, its relative importance is quite small, and that published reports to the contrary are artifactual. 10The purpose of our study was to assess the frequency of risk factors for stroke in a group of patients with CI plus MVP (study patients) and to compare the results with those from a group of patients with CI who had similar characteristics but who did not have MVP (control patients). The primary objective, therefore, was to assess possible differences in the stroke-prone profile between the two groups. Received September 17, 1987; accepted November 25, 1987. raphy; neither group had other possible anatomic sources of cerebral embolus by this study. Patients were pair-matched on the basis of age ( ± 5 years), sex, race, and type of ischemia (transient ischemic attack [TIA], large artery embolus/thrombus, or lacuna). The patients were assessed in a prospective, standardized fashion on coded forms. This format hopefully served to avoid selection bias in terms of associated factors when matching patients with and without MVP. All patients were personally evaluated and a detailed medical history, physical examination, and rev...

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“…Recently a considerable number of reports have underlined the high incidence of MVP in young patients with unexplained strokes or cerebrovascular symptoms (Hanson er Hart and Easton, 1982;Hirsowitz and Saffer, 1978;Jones er al., 1982;Julien et al, 1978;Kimball and Hedges, 1977;Saffro and Talano, 1979;Sandok and Giuliani, 1982;Watson 1979;Wilson et al, 1977;Woldoff et al, 1979), which have been attributed to thromboembolism (Bamett et al, 1976(Bamett et al, , 1980Hanson et al, 1980;Kostuk et al, 1977). Studies attempting to demonstrate such mechanisms have, nevertheless, yielded somewhat conflicting results.…”

Section: Discussionmentioning

confidence: 99%

Platelet function and coagulation studies in patients with mitral valve prolapse

Zuppiroli¹,

Cecchi²,

Ciaccheri³

et al. 1986

Clinical Cardiology

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Summary: Twenty-eight consecutive patients with mitral valve prolapse (MVP), seven of whom had previous cerebrovascular disorders (CVD), were studied for platelet function and coagulation tests. While platelet function tests were found to be normal with the exception of platelet aggregation rate (PAR), there was a significant rise of factors VIII vWF:Ag (Von Willebrand) and (FPA) fibrinopeptide A. Six cases had high levels of both these factors, suggesting the existence of a particular subset of patients with MVP, with a higher risk of thromboembolic episodes, although only three out of seven patients with previous CVD had either FPA or VIII vWF:Ag levels. The broad spectrum of subjects with MVP probably explains the different results obtained when studying platelet function and coagulation factors. Therefore, larger population studies and prolonged follow-up of cases with either coagulation abnormalities similar to the ones found in the present report and/or altered platelet function tests are suggested to discover if it is possible to detect patients with a potential for thromboembolism.

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Cerebral ischemic events in patients with mitral valve prolapse.

Cited by 45 publications

References 30 publications

Mitral Valve Prolapse with Systemic Embolism: Report of Three Cases

Mitral Valve Prolapse with Systemic Embolism: Report of Three Cases

Cerebral ischemia and mitral valve prolapse: case-control study of associated factors.

Platelet function and coagulation studies in patients with mitral valve prolapse

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