Mitral regurgitation in mitral valve prolapse syndrome: prevalence and semi-quantification by color Doppler echocardiography

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Abstract

From a group of 78 consecutive patients who were referred to the echocardiography laboratory for assessment of a mid/late systolic click and/or a mid/late pansystolic murmur, we have included 40 patients (26 women and 14 men) aged 52.4±17.1 years who met with major echocardiographic criteria for mitral valve prolapse. Severity of mitral regurgitation was semiquantitated using color Doppler flow imaging and calculating the maximum percentage of left atrial area occupied by the regurgitant jet area [(RJA/LAA) x100], obtained by planimetry in either parasternal long axis, apical four chamber or apical two chamber views. All observations were made with the same system(ATL-UM7) and color gain was optimized in each case. Regurgitation was classified as grade I when the percentage was under 20, grade II when it was between 20 and 40 % and gradeIII when it was above 40%. Mitral regurgitation was present in 36 patients (900a)and found to be grade I in18 (45%), grade II in 12 (30%) and grade III in 6(15via).The anterior leaflet, was involved in 11 patients(27.5 %),), the posterior leaflet in 19(47.50/U)and both leaflets in 10 (25%). Of the 6 patients with grade III regurgitation there were 4 men and 2 women aged 61.8±11.3 years and half of these patients required mitral valve surgery. We conclude that 90% of our patients with mitral valve prolapse present some degree of mitral regurgitation by color Doppler flow imaging, which in half the cases was mild. The posterior leaflet was the most frequently affected. Older age, male sex, the presence of a pansystolic murmur and leaflet thickening were predictors of greater degree of mitral regurgitation and of the need for mitral valve surgery.