Pediatric Mitral Valve Prolapse
Mitral valve prolapse (MVP), the most common anomaly of the mitral valve apparatus, occurs when one or both mitral valve leaflets excessively billows into the left atrium toward the end of systole. Mitral regurgitation (MR) develops in some patients with mitral valve prolapse, particularly those with more significant prolapse, when the valve edges fail to coapt. An extreme form of prolapse could include chordal rupture, in which the prolapsed mitral valve is flail. Mitral valves excised from patients with severe MR secondary to mitral valve prolapse have large leaflets and various histologic alterations.
Besides the symptoms attributable to the MR, various neuroendocrine and autonomic disturbances occur in some patients with mitral valve prolapse. In these patients, prolapse may be an epiphenomenon of the underlying autonomic or neurohumoral illness. The term mitral valve prolapse syndrome is often used to refer to the collection of these manifestations. However, in a significant proportion of patients, the mitral valve prolapse is trivial, and no such associated manifestations are present. In these patients, mitral valve prolapse constitutes an essentially benign condition.
Mitral valve prolapse syndrome was recognized as early as 1916, when Sir James MacKenzie described the soldier’s heart in spare, thin young men with great vasomotor instability, easy fatigability, breathlessness, and pain over the region of the heart. Kerley first described the syndrome in 1920, and Lincoln described the syndrome in 1928. In 1963, Barlow and colleagues made the first clinical diagnosis of the syndrome as it is known today. The advent of echocardiography led to further advances and formed the basis of current knowledge.
Idiopathic mitral valve prolapse may be congenital in some patients, but recognition may be delayed until adolescence or adulthood. Associated complicating issues include cardiac arrhythmia, heart failure secondary to severe MR (rare), and, occasionally, thromboembolic events. Familial cases are known and occur in an autosomal dominant pattern with variable penetrance and expression (familial mitral valve prolapse).
Mitral valve prolapse (MVP) is a heterogeneous disorder and may originate from various underlying causes affecting one or more portions of the mitral valve leaflets, chordae tendineae, papillary muscle, and/or valve annulus. The syndrome may occur in isolation or in association with generalized connective tissue abnormalities, such as Marfan syndrome  and Ehlers-Danlos syndrome, in which specific enzymatic defects are found. Mitral valve prolapse may occur in the context of inflammatory disease such as rheumatic fever or endocarditis. 
Isolated mitral valve prolapse can be sporadic or familial, demonstrating autosomal dominant and X-linked inheritance. Three different loci on chromosomes 16, 11, and 13 are linked to mitral valve prolapse, but no specific gene has been described. Another locus on chromosome X has also been found to cosegregate with a rare form of mitral valve prolapse called X-linked myxomatous valvular dystrophy. 
Isolated mitral valve prolapse has been independently associated with low body mass index; however, the reason for this association remains unexplained. 
Mitral valve prolapse may be secondary to rupture or dysfunction of the papillary muscles following myocardial infarction or ischemia, rupture of chordae tendineae due to infective endocarditis, or abnormal left ventricular wall motion in the setting of myocardial ischemia and/or primary myocardial disease. In these patients, the posterior leaflet in the floppy valve tends to have a significantly longer basal free-edge length and more frequent chordal rupture compared with patients with postinflammatory disease.
A connective tissue abnormality, possibly related to collagen metabolism, may underlie the idiopathic disorder. Abnormalities of collagen and elastic fibers have been documented in floppy mitral valves (FMV). Urokinase-plasminogen activator (PLAU), which is suggested in the pathogenesis of elastin and collagen degradation in arterial aneurysm, has also been implicated in mitral valve prolapse (PLAU T4065C TC genotype). TGFBR2 mutations have also been recognized among patients with mitral valve prolapse and Marfanlike phenotype.  A Marfanlike phenotype A locus for autosomal dominant mitral valve prolapse has also been described on chromosome 11p15.4.
Investigators have also suggested that floppy mitral valve/mitral valve prolapse (FMV/MVP) syndrome may not be attributable alone to the severity of the mitral regurgitation (MR) and that hypersensitivity to adrenergic stimulation related to β1-adrenergic receptor polymorphism may play a partial role in symptoms, particularly in women with FMV/MVP. 
Electron microscopy of the affected valve leaflets shows a haphazard arrangement, disruption, and fragmentation of collagen fibrils. Myxomatous proliferation of the mitral valve, in which the middle spongiosa layer is predominantly involved, leads to the presence of unusually large amounts of myxomatous material and acid mucopolysaccharide. Degeneration of collagen within the central core of the chordae tendineae may lead to chordal rupture. Mitral valve prolapse can also follow rheumatic fever and myocardial infarction, in which case the prolapse is secondary to inflammatory or ischemic chordal rupture, respectively.
Metabolic and neuroendocrine abnormalities also occur in mitral valve prolapse and may separately result in prolapse unrelated to a connective tissue disorder. Adolescents with anorexia nervosa form a distinct group, in whom mitral valve prolapse develops as a result of reduced left ventricular filling.  In such patients, increased norepinephrine and epinephrine may be found. Abnormalities in autonomic and neuroendocrine regulation have been demonstrated, including hyper-response to adrenergic stimulation, parasympathetic abnormalities (vagal withdrawal), altered baroreflex activity, renin-aldosterone regulation abnormalities, decreased intravascular volume, decreased left ventricular volume in upright posture, and atrial natriuretic factor secretion abnormalities.
Heritable disorders of connective tissue include the following:
Ehlers-Danlos syndrome types I, II, IV
Williams syndrome 
Polycystic kidney disease, adult type
Skeletal abnormalities include the following:
Straight back syndrome
Atrial septal defect (ostium secundum), including atrial septal aneurysm, tricuspid valve prolapse, aortic valve prolapse, and Ebstein anomaly of tricuspid valve
Accessory atrioventricular pathways
Coronary artery anomalies
Other diseases include the following:
Sickle cell disease
Several reports suggest magnesium deficiency underlies the disease in some patients.
United States data
Mitral valve prolapse (MVP) is the most prevalent cardiac valve disorder. Mitral valve prolapse is a common finding in otherwise healthy teenagers and young adults, particularly those patients who present with palpitations, chest pain, or dizziness. More than one third of cases in younger children are associated with other congenital heart defects. Reports vary, but 3-5% of pediatric patients likely have clinically significant mitral valve prolapse. However, a report from California places the prevalence at only 0.6%. 
Prevalence rates are 1-2% in children and 5-15% in adolescents and young adults. In a series of 278 surgically removed mitral valves with pure regurgitation, mitral valve prolapse was present in 43%. 
Some studies show mitral valve prolapse is twice as frequent in females as in males.
Although findings are more frequent in older children and adults, the defect is believed to be present at birth.
Mitral valve prolapse (MVP) is not progressive in childhood, and specific therapy is not indicated for the vast majority of patients.
Progression to significant mitral regurgitation (MR) or sudden death is rare.
Asymptomatic patients with isolated mitral systolic clicks need only counseling and reassurance.
When present, associated abnormalities dictate the risk. Presence of significant MR and prolonged QT interval on ECG may also influence outcome. QT prolongation is slightly more prevalent among patients with mitral valve prolapse and may be associated with repolarization abnormalities and arrhythmia vulnerability. When severe, MR can lead to heart failure.
As noted above, mortality is rare in children. Sudden death is also rare and occurs more often in young women with a history of recurrent syncope, sustained supraventricular tachycardia, or complex ventricular tachycardia. Family history of cardiac sudden death often is a risk-stratifying indicator.
Development of MR and the progression of mild or moderate MR to severe MR are important determinants to morbidity. One study showed that the prevalence of MR increased from 29% of patients to 43% of patients during 4.3 years of follow-up.  Other possible complications include congestive cardiac failure, rupture of chordae tendineae, infective endocarditis (in 0.1-0.3 cases per 100 patient years), thromboembolic phenomena including cerebrovascular accidents, and sudden death. Cardiac arrhythmias such as ventricular tachycardia and ventricular fibrillation are more common in mitral valve prolapse.
Complications include the following:
MR: Progression or appearance of MR is one of the main complications. Over 4.3 years, approximately 14% of patients developed MR.
Congestive cardiac failure
Rupture of chordae tendineae
Infective endocarditis, in 0.1-0.3 cases per 100 patient years
Thromboembolic phenomena including cerebrovascular accidents and sudden death
Ventricular tachycardia and fibrillation
Note the following:
Careful explanation of the clinical findings and the nature of mitral valve prolapse (MVP) help to reassure the anxious patient.
Normal activity can be allowed if mitral regurgitation (MR) is not severe
Antibiotic prophylaxis during surgery and dental procedures is only necessary if associated MR is present.
The vast majority of patients with mitral valve prolapse remain asymptomatic for their entire lives and require observation every few years for reassurance.
Patients with orthostatic syncope secondary to dehydration should take extra salt and water during and following sport activities and competition.
Pregnancy requires infective endocarditis prophylaxis during delivery. Other implications are based on the severity of MR.
Taub CC, Stoler JM, Perez-Sanz T, et al. Mitral valve prolapse in Marfan syndrome: an old topic revisited. Echocardiography. 2009 Apr. 26(4):357-64. [Medline].
Lou XF, Yang DY, Liu ZY, Wang HL, Li TS. [Clinical analysis of 120 cases of infective endocarditis] [Chinese]. Zhonghua Nei Ke Za Zhi. 2009 Jan. 48 (1):35-8. [Medline].
Grau JB, Pirelli L, Yu PJ, Galloway AC, Ostrer H. The genetics of mitral valve prolapse. Clin Genet. 2007 Oct. 72(4):288-95. [Medline].
Movahed MR, Hepner AD. Mitral valvar prolapse is significantly associated with low body mass index in addition to mitral and tricuspid regurgitation. Cardiol Young. 2007 Apr. 17(2):172-4. [Medline].
Attias D, Stheneur C, Roy C, et al. Comparison of clinical presentations and outcomes between patients with TGFBR2 and FBN1 mutations in Marfan syndrome and related disorders. Circulation. 2009 Dec 22. 120(25):2541-9. [Medline].
Theofilogiannakos EK, Boudoulas KD, Gawronski BE, et al. Floppy mitral valve/mitral valve prolapse syndrome: Beta-adrenergic receptor polymorphism may contribute to the pathogenesis of symptoms. J Cardiol. 2015 May. 65 (5):434-8. [Medline].
Yahalom M, Spitz M, Sandler L, Heno N, Roguin N, Turgeman Y. The significance of bradycardia in anorexia nervosa. Int J Angiol. 2013 Jun. 22(2):83-94. [Medline].
Bajracharya P, Bhatnagar S, Pauliks LB. Mitral valve diseases in Williams syndrome-case report and review of the literature. Echocardiography. 2011 Sep. 28(8):E156-9. [Medline].
Hepner AD, Ahmadi-Kashani M, Movahed MR. The prevalence of mitral valve prolapse in patients undergoing echocardiography for clinical reason. Int J Cardiol. 2007 Dec 15. 123(1):55-7. [Medline].
Cheunsuchon P, Chuangsuwanich T, Samanthai N, Warnnissorn M, Leksrisakul P, Thongcharoen P. Surgical pathology and etiology of 278 surgically removed mitral valves with pure regurgitation in Thailand. Cardiovasc Pathol. 2007 Mar-Apr. 16(2):104-10. [Medline].
Deng YB, Takenaka K, Sakamoto T, et al. Follow-up in mitral valve prolapse by phonocardiography, M-mode and two-dimensional echocardiography and Doppler echocardiography. Am J Cardiol. 1990 Feb 1. 65(5):349-54. [Medline].
Cetinkaya M, Semizel E, Bostan O, Cil E. Risk of vasovagal syncope and cardiac arrhythmias in children with mitral valve prolapse. Acta Cardiol. 2008 Jun. 63(3):395-8. [Medline].
Markiewicz-Loskot G, Loskot M, Moric-Janiszewska E, et al. Electrocardiographic abnormalities in young athletes with mitral valve prolapse. Clin Cardiol. 2009 Aug. 32(8):E36-9. [Medline].
Atalay S, Ucar T, Ozcelik N, Ekici F, Tutar E. Echocardiographic evaluation of mitral valve in patients with pure rheumatic mitral regurgitation. Turk J Pediatr. 2007 Apr-Jun. 49(2):148-53. [Medline].
Gutierrez-Chico JL, Zamorano Gomez JL, Rodrigo-Lopez JL, et al. Accuracy of real-time 3-dimensional echocardiography in the assessment of mitral prolapse. Is transesophageal echocardiography still mandatory?. Am Heart J. 2008 Apr. 155(4):694-8. [Medline].
Seliem MA, Fedec A, Szwast A, et al. Atrioventricular valve morphology and dynamics in congenital heart disease as imaged with real-time 3-dimensional matrix-array echocardiography: comparison with 2-dimensional imaging and surgical findings. J Am Soc Echocardiogr. 2007 Jul. 20(7):869-76. [Medline].
Beraud AS, Schnittger I, Miller DC, Liang DH. Multiplanar reconstruction of three-dimensional transthoracic echocardiography improves the presurgical assessment of mitral prolapse. J Am Soc Echocardiogr. 2009 Aug. 22(8):907-13. [Medline].
[Guideline] American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation. 2006 Aug 1. 114(5):e84-231. [Medline].
Boon R, Hazekamp M, Hoohenkerk G, et al. Artificial chordae for pediatric mitral and tricuspid valve repair. Eur J Cardiothorac Surg. 2007 Jul. 32(1):143-8. [Medline].
Miura T, Eishi K, Yamachika S, et al. Mitral valve repair for degenerative disease with leaflet prolapse: to improve long-term outcomes. Gen Thorac Cardiovasc Surg. 2009 Jan. 57(1):10-21. [Medline].
Zegdi R, Sleilaty G, Latremouille C, et al. Reoperation for failure of mitral valve repair in degenerative disease: a single-center experience. Ann Thorac Surg. 2008 Nov. 86(5):1480-4. [Medline].
Javadikasgari H, Suri RM, Tappuni B, et al. Robotic mitral valve repair for degenerative posterior leaflet prolapse. Ann Cardiothorac Surg. 2017 Jan. 6 (1):27-32. [Medline].
Vricella LA, Ravekes WA, Arbustini E, Jet al. Simplified mitral valve repair in pediatric patients with connective tissue disorders. J Thorac Cardiovasc Surg. 2017 Feb. 153 (2):399-403. [Medline].
Vaidya VR, DeSimone CV, Damle N, et al. Reduction in malignant ventricular arrhythmia and appropriate shocks following surgical correction of bileaflet mitral valve prolapse. J Interv Card Electrophysiol. 2016 Aug. 46 (2):137-43. [Medline].
Tacoy G, Balcioglu AS, Arslan U, et al. Effect of metoprolol on heart rate variability in symptomatic patients with mitral valve prolapse. Am J Cardiol. 2007 Jun 1. 99(11):1568-70. [Medline].
AAP. Mitral valve prolapse and athletic participation in children and adolescents. Pediatrics. 1995 May. 95(5):789-90. [Medline].
Bassili A, Mokhtar SA, Dabous NI, et al. Congenital heart disease among school children in Alexandria, Egypt: an overview on prevalence and relative frequencies. J Trop Pediatr. 2000 Dec. 46(6):357-62. [Medline].
Beroukhim RS, Reed JH, Schaffer MS, Yetman AT. Surgical correction of mitral valve prolapse : a cure for recurrent ventricular tachycardia in Marfan syndrome?. Pediatr Cardiol. 2006 Nov-Dec. 27(6):755-8. [Medline].
Bisset GS, Schwartz DC, Meyer RA, et al. Clinical spectrum and long-term follow-up of isolated mitral valve prolapse in 119 children. Circulation. 1980 Aug. 62(2):423-9. [Medline].
Blum A, Shapira Y, Yeganh S, Rabinkov M. Mitral valve prolapse and thromboembolic events. Isr Med Assoc J. 2001 Apr. 3(4):282-3. [Medline].
Carolei A, Marini C, Ferranti E, et al. A prospective study of cerebral ischemia in the young. Analysis of pathogenic determinants. The National Research Council Study Group. Stroke. 1993 Mar. 24(3):362-7. [Medline].
Chauvaud S. Congenital mitral valve surgery: techniques and results. Curr Opin Cardiol. 2006 Mar. 21(2):95-9. [Medline].
Cheng TO. Heart rate variability and QT dispersion in mitral valve prolapse. J Electrocardiol. 2001 Jan. 34(1):89. [Medline].
Cheng TO, Wang XF, Zheng LH, Li ZA, Lu P. Three-dimensional transesophageal echocardiography in the diagnosis of mitral valve prolapse. Am Heart J. 1994 Dec. 128(6 Pt 1):1218-24. [Medline].
Chou HT, Chen YT, Shi YR, Tsai FJ. Association between angiotensin I-converting enzyme gene insertion/deletion polymorphism and mitral valve prolapse syndrome. Am Heart J. 2003 Jan. 145(1):169-73. [Medline].
Chou HT, Hung JS, Chen YT, Shi YR, Tsai FJ. Association between angiotensinogen gene M235T polymorphism and mitral valve prolapse syndrome in Taiwan Chinese. J Heart Valve Dis. 2002 Nov. 11(6):830-6. [Medline].
Chou HT, Shi YR, Hsu Y, Tsai FJ. Association between fibrillin-1 gene exon 15 and 27 polymorphisms and risk of mitral valve prolapse. J Heart Valve Dis. 2003 Jul. 12(4):475-81. [Medline].
Colomina MJ, Puig L, Godet C, Villanueva C, Bago J. Prevalence of asymptomatic cardiac valve anomalies in idiopathic scoliosis. Pediatr Cardiol. 2002 Jul-Aug. 23(4):426-9. [Medline].
Cooke RA, Chambers JB. Anorexia nervosa and the heart. Br J Hosp Med. 1995 Oct 4-17. 54(7):313-7. [Medline].
Corrado D, Basso C, Nava A, Rossi L, Thiene G. Sudden death in young people with apparently isolated mitral valve prolapse. G Ital Cardiol. 1997 Nov. 27(11):1097-105. [Medline].
Corrado D, Thiene G, Nava A, Rossi L, Pennelli N. Sudden death in young competitive athletes: clinicopathologic correlations in 22 cases. Am J Med. 1990 Nov. 89(5):588-96. [Medline].
Corrao S, Scaglione R, Arnone S, Licata G. Left ventricular diastolic filling alterations in subjects with mitral valve prolapse: a Doppler echocardiographic study. Eur Heart J. 1993 Mar. 14(3):369-72. [Medline].
David TE, Omran A, Armstrong S, Sun Z, Ivanov J. Long-term results of mitral valve repair for myxomatous disease with and without chordal replacement with expanded polytetrafluoroethylene sutures. J Thorac Cardiovasc Surg. 1998 Jun. 115(6):1279-85; discussion 1285-6. [Medline].
Dreyfus GD, Corbi P, Rubin S, Aubert S. Posterior leaflet preservation in mitral valve prolapse: a new approach to mitral repair. J Heart Valve Dis. 2006 Jul. 15(4):528-30. [Medline].
Freed LA, Acierno JS, Dai D, et al. A locus for autosomal dominant mitral valve prolapse on chromosome 11p15.4. Am J Hum Genet. 2003 Jun. 72(6):1551-9. [Medline].
Fuzellier JF, Chauvaud SM, Fornes P, et al. Surgical management of mitral regurgitation associated with Marfan’s syndrome. Ann Thorac Surg. 1998 Jul. 66(1):68-72. [Medline].
Glesby MJ, Pyeritz RE. Association of mitral valve prolapse and systemic abnormalities of connective tissue. A phenotypic continuum. JAMA. 1989 Jul 28. 262(4):523-8. [Medline].
Gorgulu S, Eren M, Norgaz T, Tezel T. Comparison of echocardiographic methods in assessing severity of mitral regurgitation in patients with mitral valve prolapse. J Heart Valve Dis. 2004 Jan. 13(1):38-45. [Medline].
Hamada T, Koshino Y, Misawa T, Isaki K, Gejyo F. Mitral valve prolapse and autonomic function in panic disorder. Acta Psychiatr Scand. 1998 Feb. 97(2):139-43. [Medline].
Henneke KH, Pongratz G, Feistel H, et al. Assessment of cardiac adrenergic supply in mitral valve prolapse using m-[123I]iodobenzylguanidine scintigraphy. Int J Cardiol. 1992 Dec. 37(3):389-94. [Medline].
Ismajli J, Shabani X, Manaj R, Emini M, Bajraktari G. Mitral valve prolapse, atrial flutter, and syncope in a young female patient. Med Sci Monit. 2006 Nov. 12(11):CS110-3. [Medline].
James PA, Aftimos S, Skinner JR. Familial mitral valve prolapse associated with short stature, characteristic face, and sudden death. Am J Med Genet A. 2003 May 15. 119(1):32-6. [Medline].
Kaminer SJ, Hixon RL, Strong WB. Evaluation and recommendations for participation in athletics for children with heart disease. Curr Opin Pediatr. 1995 Oct. 7(5):595-600. [Medline].
Karakurum B, Topcu S, Yildirim T, Karatas M, Turan I, Tan M. Silent cerebral infarct in patients with mitral valve prolapse. Int J Neurosci. 2005 Nov. 115(11):1527-37. [Medline].
Karavidas AI, Lazaros GA, Zampoulakis JD, et al. Prevalence of mitral valve prolapse and thick mitral valve in a non-selected outpatient population. Cardiology. 2002. 98(3):165-6. [Medline].
Kasegawa H, Shimokawa T, Shibazaki I, Hayashi H, Koyanagi T, Ida T. Mitral valve repair for anterior leaflet prolapse with expanded polytetrafluoroethylene sutures. Ann Thorac Surg. 2006 May. 81(5):1625-31. [Medline].
Katsanos KH, Pappas CJ, Patsouras D, et al. Alarming atrioventricular block and mitral valve prolapse in the Kearns-Sayre syndrome. Int J Cardiol. 2002 May. 83(2):179-81. [Medline].
Kim S, Kuroda T, Nishinaga M, et al. Relationship between severity of mitral regurgitation and prognosis of mitral valve prolapse: echocardiographic follow-up study. Am Heart J. 1996 Aug. 132(2 Pt 1):348-55. [Medline].
Kitlinski M, Stepniewski M, Nessler J, et al. Is magnesium deficit in lymphocytes a part of the mitral valve prolapse syndrome?. Magnes Res. 2004 Mar. 17(1):39-45. [Medline].
Kligfield P, Devereux RB. Arrhythmia in mitral valve prolapse. Podrid PR, Kowey PR eds. Cardiac arrhythmia: mechanisms, diagnosis and management. Baltimore, Md: Williams and Wilkins; 1995. 1253-65.
Komoda T, Hubler M, Siniawski H, Hetzer R. Annular stabilization in mitral repair without a prosthetic ring. J Heart Valve Dis. 2000 Nov. 9(6):776-82. [Medline].
Koutlianos NA, Kouidi EJ, Metaxas TI, Deligiannis AP. Non-invasive cardiac electrophysiological indices in soccer players with mitral valve prolapse. Eur J Cardiovasc Prev Rehabil. 2004 Oct. 11(5):435-41. [Medline].
Kulan K, Komsuoglu B, Tuncer C. Significance of QT dispersion on ventricular arrhythmias in mitral valve prolapse. Int J Cardiol. 1996 Jun. 54(3):251-7. [Medline].
Lichodziejewska B, Klos J, Rezler J, et al. Clinical symptoms of mitral valve prolapse are related to hypomagnesemia and attenuated by magnesium supplementation. Am J Cardiol. 1997 Mar 15. 79(6):768-72. [Medline].
Loupa C, Mavroidi N, Boutsikakis, et al. Infective endocarditis in Greece: a changing profile. Epidemiological, microbiological and therapeutic data. Clin Microbiol Infect. 2004 Jun. 10(6):556-61. [Medline].
Lumiaho A, Ikaheimo R, Miettinen R, et al. Mitral valve prolapse and mitral regurgitation are common in patients with polycystic kidney disease type 1. Am J Kidney Dis. 2001 Dec. 38(6):1208-16. [Medline].
Malkowski MJ, Guo R, Orsinelli DA, et al. The morphologic characteristics of flail mitral leaflets by transesophageal echocardiography. J Heart Valve Dis. 1997 Jan. 6(1):54-9. [Medline].
Marks AR, Choong CY, Sanfilippo AJ, et al. Identification of high-risk and low-risk subgroups of patients with mitral-valve prolapse. N Engl J Med. 1989 Apr 20. 320(16):1031-6. [Medline].
McDonnell NB, Gorman BL, Mandel KW, Schurman SH, Assanah-Carroll A, Mayer SA. Echocardiographic findings in classical and hypermobile Ehlers-Danlos syndromes. Am J Med Genet A. 2006 Jan 15. 140(2):129-36. [Medline].
Micieli G, Cavallini A, Melzi d’Eril GV, et al. Haemodynamic and neurohormonal responsiveness to different stress tests in mitral valve prolapse. Clin Auton Res. 1991 Dec. 1(4):323-7. [Medline].
Muller S, Muller L, Laufer G, et al. Comparison of three-dimensional imaging to transesophageal echocardiography for preoperative evaluation in mitral valve prolapse. Am J Cardiol. 2006 Jul 15. 98(2):243-8. [Medline].
Murakami T, Yagihara T, Yamamoto F, et al. Artificial chordae for mitral valve reconstruction in children. Ann Thorac Surg. 1998 May. 65(5):1377-80. [Medline].
Nascimento R, Freitas A, Teixeira F, et al. Is mitral valve prolapse a congenital or acquired disease?. Am J Cardiol. 1997 Jan 15. 79(2):226-7. [Medline].
Oke DA, Ajuluchukwu JN, Mbakwem A, et al. Clinical and echocardiographic assessment of Nigerian patients seen at the Lagos University Teaching Hospital with features of mitral valve prolapse. West Afr J Med. 2000 Jul-Sep. 19(3):200-5. [Medline].
Panther R, Mahmood S, Gal R. Echocardiography in the diagnostic evaluation of syncope. J Am Soc Echocardiogr. 1998 Mar. 11(3):294-8. [Medline].
Patel V, Hsiung MC, Nanda NC, et al. Usefulness of live/real time three-dimensional transthoracic echocardiography in the identification of individual segment/scallop prolapse of the mitral valve. Echocardiography. 2006 Jul. 23(6):513-8. [Medline].
Pini R, Greppi B, Roman MJ, et al. Time-motion reconstruction of mitral leaflet motion from two-dimensional echocardiography in mitral valve prolapse. Am J Cardiol. 1991 Jul 15. 68(2):215-20. [Medline].
Rezaian GR, Emad A. Mitral valve prolapse in patients with pure rheumatic mitral stenosis: an angiographic study. Angiology. 2001 Apr. 52(4):267-71. [Medline].
Ronneberger DL, Hausmann R, Betz P. Sudden death associated with myxomatous transformation of the mitral valve in an 8-year-old boy. Int J Legal Med. 1998. 111(4):199-201. [Medline].
Savage DD, Devereux RB, Garrison RJ, et al. Mitral valve prolapse in the general population. 2. Clinical features: the Framingham Study. Am Heart J. 1983 Sep. 106(3):577-81. [Medline].
Seliem MA, Duffy CE, Gidding SS, et al. Echocardiographic evaluation of the aortic root and mitral valve in children and adolescents with isolated pectus excavatum: comparison with Marfan patients. Pediatr Cardiol. 1992 Jan. 13(1):20-3. [Medline].
Smedira NG, Selman R, Cosgrove DM, et al. Repair of anterior leaflet prolapse: chordal transfer is superior to chordal shortening. J Thorac Cardiovasc Surg. 1996 Aug. 112(2):287-91; discussion 291-2. [Medline].
Stoddard MF, Prince CR, Dillon S, et al. Exercise-induced mitral regurgitation is a predictor of morbid events in subjects with mitral valve prolapse. J Am Coll Cardiol. 1995 Mar 1. 25(3):693-9. [Medline].
Strom BL, Abrutyn E, Berlin JA, et al. Dental and cardiac risk factors for infective endocarditis. A population-based, case-control study. Ann Intern Med. 1998 Nov 15. 129(10):761-9. [Medline].
Suchon E, Podolec P, Plazak W, et al. Mitral valve prolapse associated with ostium secundum atrial septal defect–a functional disorder. Acta Cardiol. 2004 Apr. 59(2):237-8. [Medline].
Suri RM, Schaff HV, Dearani JA, et al. Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg. 2006 Sep. 82(3):819-26. [Medline].
Tayel S, Kurczynski TW, Levine M, et al. Marfanoid children. Etiologic heterogeneity and cardiac findings. Am J Dis Child. 1991 Jan. 145(1):90-3. [Medline].
Terechtchenko L, Doronina SA, Pochinok EM, Riftine A. Autonomic tone in patients with supraventricular arrhythmia associated with mitral valve prolapse in young men. Pacing Clin Electrophysiol. 2003 Jan. 26(1 Pt 2):444-6. [Medline].
Toren P, Eldar S, Cendorf D, et al. The prevalence of mitral valve prolapse in children with anxiety disorders. J Psychiatr Res. 1999 Jul-Aug. 33(4):357-61. [Medline].
Van Der Ham DP, De Vries JK, Van Der Merwe PL. Mitral valve prolapse: a study of 45 children. Cardiovasc J S Afr. 2003 Jul-Aug. 14(4):191-4. [Medline].
Venugopalan P, Agarwal AK, Johnston WJ, Riveria E. Spread of heart diseases seen in an open-access paediatric echocardiography clinic. Int J Cardiol. 2002 Aug. 84(2-3):211-6. [Medline].
Venugopalan P, Joshi SN. Cardiac involvement in infantile Sandhoff disease. J Paediatr Child Health. 2002 Feb. 38(1):98-100. [Medline].
[Guideline] Wilson W, Taubert KA, Gewitz M, American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee… Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007 Oct 9. 116 (15):1736-54. [Medline].
Woolf PK, Gewitz MH, Berezin S, et al. Noncardiac chest pain in adolescents and children with mitral valve prolapse. J Adolesc Health. 1991 May. 12(3):247-50. [Medline].
Wu MH, Lue HC, Wang JK, Wu JM. Implications of mitral valve prolapse in children with rheumatic mitral regurgitation. J Am Coll Cardiol. 1994 Apr. 23(5):1199-203. [Medline].
Zuppiroli A, Mori F, Favilli S, et al. “Natural histories” of mitral valve prolapse. Influence of patient selection on cardiovascular event rates. Ital Heart J. 2001 Feb. 2(2):107-14. [Medline].
Imamoglu EY, Eroglu AG. QT dispersion and ventricular arrhythmias in children with primary mitral valve prolapse. Turk Pediatri Ars. 2016 Sep 1. 51 (3):135-41. [Medline].
Syed FF, Ackerman MJ, McLeod CJ, et al. Sites of successful ventricular fibrillation ablation in bileaflet mitral valve prolapse syndrome. Circ Arrhythm Electrophysiol. 2016 May. 9 (5):[Medline].
Silverman NH. Echocardiography of congenital mitral valve disorders: echocardiographic-morphological comparisons. Cardiol Young. 2014 Dec. 24 (6):1030-48. [Medline].
Towbin JA. Ion channel dysfunction associated with arrhythmia, ventricular noncompaction, and mitral valve prolapse: a new overlapping phenotype. J Am Coll Cardiol. 2014 Aug 26. 64 (8):768-71. [Medline]. [Full Text].
Hien MD, Großgasteiger M, Weymann A, Rauch H, Rosendal C. Reproducibility in echocardiographic two- and three-dimensional mitral valve assessment. Echocardiography. 2014 Mar. 31 (3):311-7. [Medline].
Kutty S, Colen TM, Smallhorn JF. Three-dimensional echocardiography in the assessment of congenital mitral valve disease. J Am Soc Echocardiogr. 2014 Feb. 27 (2):142-54. [Medline].
Sriram CS, Syed FF, Ferguson ME, et al. Malignant bileaflet mitral valve prolapse syndrome in patients with otherwise idiopathic out-of-hospital cardiac arrest. J Am Coll Cardiol. 2013 Jul 16. 62 (3):222-30. [Medline].
Gavrovska A, Zajic G, Reljin I, Reljin B. Classification of prolapsed mitral valve versus healthy heart from phonocardiograms by multifractal analysis. Comput Math Methods Med. 2013. 2013:376152. [Medline].
Amoozgar H, Rafizadeh H, Ajami G, Borzoee M. The prevalence of hypomagnesaemia in pediatric patients with mitral valve prolapse syndrome and the effect of mg therapy. Int Cardiovasc Res J. 2012 Sep. 6 (3):92-5. [Medline].
Hien MD, Weymann A, Rauch H, Grossgasteiger M, Motsch J, Rosendal C. Comparison of intraoperative three-dimensional Doppler color flow mapping to assess mitral regurgitation. Echocardiography. 2012 Aug. 29 (7):849-57. [Medline].
Janiec I, Werner B, Sieminska J, Ravens-Sieberer U. Quality of life of children with mitral valve prolapse. Qual Life Res. 2011 May. 20 (4):537-41. [Medline].
Babaoglu K, Altun G, Binnetoğlu K. P-wave dispersion and heart rate variability in children with mitral valve prolapse. Pediatr Cardiol. 2011 Apr. 32 (4):449-54. [Medline].
Espinola-Zavaleta N, Iqbal FM, Nanda NC, et al. Echocardiographic study of a Mestizo-Mexican population with Marfan syndrome. Echocardiography. 2010 Sep. 27 (8):923-30. [Medline].
Bayer-Topilsky T, Suri RM, Topilsky Y, et al. Mitral valve prolapse, psychoemotional status, and quality of life: prospective investigation in the current era. Am J Med. 2016 Oct. 129 (10):1100-9. [Medline].
Termine C, Trotti R, Ondei P, et al. Mitral valve prolapse and abnormalities of haemostasis in children and adolescents with migraine with aura and other idiopathic headaches: a pilot study. Acta Neurol Scand. 2010 Aug. 122 (2):91-6. [Medline].
Poothirikovil Venugopalan, MBBS, MD, FRCPCH Consultant Pediatrician with Cardiology Expertise, Department of Child Health, Brighton and Sussex University Hospitals, NHS Trust; Honorary Senior Clinical Lecturer, Brighton and Sussex Medical School, UK
Poothirikovil Venugopalan, MBBS, MD, FRCPCH is a member of the following medical societies: British Congenital Cardiac Association, Paediatrician with Cardiology Expertise Special Interest Group, Royal College of Paediatrics and Child Health
Disclosure: Nothing to disclose.
Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Nothing to disclose.
Julian M Stewart, MD, PhD Associate Chairman of Pediatrics, Director, Center for Hypotension, Westchester Medical Center; Professor of Pediatrics and Physiology, New York Medical College
Disclosure: Received research grant from: Lundbeck Pharmaceuticals<br/>Received grant/research funds from Lundbeck Pharmaceuticals for none.
Syamasundar Rao Patnana, MD Professor of Pediatrics and Medicine, Division of Cardiology, Emeritus Chief of Pediatric Cardiology, University of Texas Medical School at Houston and Children’s Memorial Hermann Hospital
Syamasundar Rao Patnana, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography and Interventions, Society for Pediatric Research
Disclosure: Nothing to disclose.
Charles I Berul, MD Professor of Pediatrics and Integrative Systems Biology, George Washington University School of Medicine; Chief, Division of Cardiology, Children’s National Medical Center
Charles I Berul, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Cardiac Electrophysiology Society, Heart Rhythm Society, Pediatric and Congenital Electrophysiology Society, Society for Pediatric Research
Disclosure: Received research grant from: Medtronic.
Pediatric Mitral Valve Prolapse
Research & References of Pediatric Mitral Valve Prolapse|A&C Accounting And Tax Services