Mitral valve prolapse: an underestimated cause of sudden cardiac death—a current review of the literature

Abstract

Mitral valve prolapse (MVP) is a common valve abnormality in general population. Despite the general belief of a benign disorder, several articles since the 1980s report sudden cardiac death (SCD) in MVP patients, with a substantial percentage of asymptomatic young individuals. The problem is to detect those patients at increased risk and implement methods that are suitable to prevent cardiac arrest. This review investigates the correlation between MVP and SCD, the understanding of the pathophysiology, the strategies for detecting those at risk and treatment options. A complete literature survey was performed using PubMed database search to gather available information regarding MVP and SCD. A total of 33 studies met selection criteria for inclusion in the review. MVP is an underrated cause of arrhythmic SCD. The subset of patients with malignant MVP who may be at greater risk for SCD is characterized by young women with bileaflet MVP, biphasic or inverted T waves in the inferior leads, and frequent complex ventricular ectopic activity with documented ventricular bigeminy or ventricular tachycardia (VT) and premature ventricular contractions (PVCs) configurations of outflow tract alternating with fascicular origin or papillary muscle. MVP is a common condition in the general population and is often encountered in asymptomatic individuals. The existing literature continues to generate significant controversy regarding the association of MVP with ventricular arrhythmias and SCD. Early echocardiography and cardiac magnetic resonance (CMR) are essential, as is a greater understanding of the potential electrophysiological processes of primary arrhythmogenesis and the evaluation of the genetic substrate.

Usefulness of Cardiac Magnetic Resonance Images for Prediction of Sudden Cardiac Arrest in Patients with Mitral Valve Prolapse: A Multicenter Retrospective Cohort Study

“…A number of studies commonly reported young age and female sex as likely risk factors. (3)(4)(5)16) A partial similarity was observed between the present study and past studies with regard to age being a risk factor for SCA though it was not revealed as an independent predictor of SCA. It might be because of the exclusion of old patients who experienced SCA or VA due to other concurrent cardiac diseases or other possible causes of SCA rather than MVP.…”

Mechanical strain induces a pro-fibrotic phenotype in human mitral valvular interstitial cells through RhoC/ROCK/MRTF-A and Erk1/2 signaling pathways

“…Modifications of the physiological valvular geometry linked to a progressive inappropriate ECM remodeling result in abnormal perception and responsiveness of VIC to mechanical stress which, in turn, may lead to a vicious circle and contribute to perpetuation of the disease [2].These structural defects prevent the complete closure of the valve causing symptoms of prolapse and regurgitation which ultimately lead to heart failure and to a significant morbidity and mortality [6,7]. Besides surgery for the severe forms of MMV, the medical therapies used in some patients aim at limiting the left ventricular remodeling but do not address the primary mechanism of mitral valve dysfunction.…”

Severe adverse events following benzathine penicillin G injection for rheumatic heart disease prophylaxis: cardiac compromise more likely than anaphylaxis

“…Pre-existing cardiac disease may be associated with systemic adverse reactions and contribute to an impaired response to resuscitation 39. In particular, it is well established that mitral valve disease is a risk factor for arrhythmias and sudden cardiac death 40. Pain or fear of BPG administration could drive a physiological response precipitating decompensation or arrhythmic events.…”