Mitral valve prolapse in children: a problem defined by real-time cross-sectional echocardiography.

Abstract

The cross-sectional echocardiographic features of mitral valve prolapse were defined in 26 children (ages 2-18 years) using a real-time, multiple-crystal ultrasound scanner. In each patient the physical findings of the mitral valve click-murmur syndrome were present and mitral valve prolapse had been diagnosed previously by conventional single crystal echocardiography. Mitral prolapse occurred in a familial setting in eight patients and was associated with the Marfan syndrome in five. Real-time two-dimensional echocardiography uniformly disclosed maximum mitral arching and the superior-posterior prolapse. These visual observations were confirmed by M-mode recordings derived from single elements within the array of 20 crystals. The method allowed a complete M-mode description of the phasic motion of the entire mitral apparatus and observations of the spectrum of prolapse from discrete late systolic prolapse to "hammock-like" holosystolic prolapse. Further, the recording of multiple systolic M-mode lines occurred when the ultrasound beam intersected the arched leaflets more than once. Pseudosystolic anterior motion was observed often and resulted clearly from a superimposition of echoes from the mitral annulus and from the posterior-superiorly arched prolapsed leaflets. A major finding in 22 patients was the association with prolapse of biconvex enlargement of the aortic sinuses of Valsalva and a significant increase in the diameter of the aortic root. Aortic root dilatation was most marked in, but not confined to, patients with the Marfan syndrome and was a prominent finding in six patients with minor musculoskeletal abnormalities. The presence of aortic root dilatation in children with normal body habitus raises important questions concerning the generalized nature of an abnormality of cardiac connective tissue in patients with mitral prolapse. The cross-sectional approach significantly enhances the noninvasive evaluation of mitral valve prolapse and provides an explanation for many of the single crystal observations reported previously.

Systolic anterior motion in the absence of asymmetric septal hypertrophy. A buckling phenomenon of the chordae tendineae.

“…Furthermore, in a recent preliminary report, Pearlman and co-workers have also described buckling of the mitral chordae (often involving the tip of the anterior leaflet as well) as the etiology for SAM in MVP.29 Our findings do not confirm the suggestion of Sahn et al that the appearance of SAM in mitral valve prolapse is created by superimposition of the mitral annulus and mitral valve leaflet. 18 MCB differs from the SAM of the anterior mitral leaflet into the left ventricular outflow tract initially described for hypertrophic obstructive cardiomyopathy by Henry et al30 More recently, however, other workers have emphasized other mechanisms for the production of SAM in hypertrophic cardiomyopathy. Rodger3' described SAM as a complex of echoes from the chordae tendineae, the papillary muscle and the anterior mitral leaflet, the latter structure being the furthest from and not impinging upon the septum.…”

Quantitation of the Degree of Mitral Valve Prolapse by Novel Software System: New Insights From Transthoracic Real-Time Three-Dimensional Echocardiography

“…To our knowledge, this is the first report of the quantification of the degree of mitral valve prolapse from 3D view, by using 3D echocardiographic images in the clinical setting. Currently, mitral valve prolapse is defined as an existence of leaflet exceeding the annular level by 2D echocardiography [10][11][12][13]. However in 2D echocardiographic images, annular level is simply set by drawing a straight line connecting two points of the annulus, which is known to have a characteristic curvature called the "saddle-shaped annulus."…”

“…Currently, mitral valve prolapse is defined as an existence of leaflet exceeding the annular level by 2D echocardiography [10][11][12][13]. However, the annular level set by 2D echo differs in each view because of the "saddle-shape" of the annulus [14].…”

Mitral Valve Prolapse: A Comparative Study with Two-Dimensional and Doppler Echocardiography, Auscultation, Conventional and Esophageal Phonocardiography

“…After the introduction of echocardiography, first Mmode [12] and later two-dimensional (2D-echo), MYP patterns were described [13], while Gilbert et al [14] cor related the 2D-echo diagnosis with LV angiography. Since then innumerable échocardiographie studies have been published, and MVP has become an échocardiographie diagnosis.…”