Pediatric Cardiology and Cardiac Surgery
Vol.24 No.1 2008 (26-30)
Toshiharu Miyake, Tohru Shinohara, Megumi Ikeoka , and Tsukasa Takemura
Department of Pediatrics, Kinki University School of Medicine, Osaka, Japan
Background: There are only a few follow-up studies of mitral valve prolapse (MVP) in children and adolescents. We evaluated the clinical features and mid-term prognosis of children and adolescents with MVP followed up over a 5-year period.
Methods: The subjects consisted of 168 patients with MVP ranging from 0.2 to 18.8 years of age (mean, 10.3 years). In 85 patients followed up over 5 years, the mean follow-up period was 10.4 years. Patients with a left ventricular end-diastolic dimension over 120% of the normal value were graded as moderate.
Results: The position of prolapse was as follows: anterior (166), posterior (1), and anterior and posterior (1). In 2 (6%) of 34 patients followed up over a 5-year period and without systolic regurgitant murmur (SRM) at the initial evaluation, an SRM appeared during the follow-up period. In 17 (37%) of 46 patients with an SRM and mitral regurgitation (MR) of mild grade at the initial examination, the SRM diminished. MR progressed to moderate grade during the follow-up period in 2 patients (4%). One patient had prolapse of the posterior mitral leaflet, and another patient with prolapse of the anterior mitral leaflet had prolapse of the posterior leaflet during the follow-up period. Neither of them had received any medication in their twenties. In all 5 patients with moderate MR at initial echocardiography, SRM diminished during the follow-up period and did not reappear until 13 to 20 years of age. Surgical operations for severe mitral regurgitation were done in 4 patients (2%) ranging in age from 1.3 to 19 years of age (mean 10.8 years). Initially, 2 of 4 patients had been followed up without medication.
Conclusions: 1) In the majority of patients with MVP and SRM, MR did not progress during childhood and adolescence. In 43% of patients, the grade of MR decreased. 2) We consider that in patients with prolapse of the posterior mitral leaflet there is a need to examine the progression of MR. 3) Even in patients with severe MR who underwent surgical repair, there was a period in which the grade of MR was mild or moderate. Thus, it is considered that some patients with mild or moderate MR may progress to severe MR.