Am J Cardiovasc Dis 2012;2(3):152-159
Original Article
Effect of lesional differences in prolapsed leaflets on clinical outcomes in
patients with mitral valve prolapsed
Keiko Suzuki, Mitsushige Murata, Risako Yasuda, Hikaru Tsuruta, Naoki Tomotsugu, Takayuki Abe, Shiro Iwanaga, Makoto
Akaishi, Keiichi Fukuda
Department of Cardiology; Department of Laboratory Medicine; Center for Clinical Research, Keio University, School of
Medicine, Tokyo, Japan; Department of Cardiology, Tokyo Medical Universtiy, Tokyo, Japan; Department of Cardiology,
Kitasato University Kitasato Institute Hospital, Tokyo, Japan
Received March 31, 2012; accepted May 27, 2012; Epub July 25, 2012; Published August 15, 2012
Abstract: Background: Mitral valve prolapse (MVP) is usually benign, although serious complications may occur. It remains
unclear whether the region of prolapsed mitral leaflets might affect prognosis. The aim of this study was to investigate
lesional differences of clinical courses of MVP. Methods and Results: We retrospectively investigated 128 MVP patients
who had been followed up for for a mean of 56.4 month. They were classified prolapse of the anterior mitral leaflet (AML, n
= 59), posterior mitral leaflet (PML, n = 47), or both leaflets (AML & PML, n = 22). Echocardiographic and clinical data were
examined from medical records. Average time to clinical events; MV surgery, new onset of atrial fibrillation (AF),
echocardiographic evidence of new chordal rupture, and worsening of mitral regurgitation severity were all significantly
shorter in PML prolapse than in those with AML or AML & PML prolapse. Increases in the left ventricular dimensions and
estimated pulmonary arterial systolic pressures were significantly larger in PML prolapse, compared with AML or AML &
PML prolapses. A subanalysis of PML prolapse revealed that new chordal rupture tended to be more frequent in middle
scallop prolapse cases (48%) compared with lateral and medial scallops (18%). In contrast, new onset of AF tended to
occur in lateral and medial scallop prolapses (44%) compared with middle scallop prolapse (20%). Conclusions: PML
prolapse patients had a poor outcome, compared with AML or AML & PML prolapse patietns. Precise regional evaluation of
the prolapsed leaflets may predict cardiac complications in MVP. (AJCD1203007).
Keywords: Mitral valve prolapse, mitral regurgitation, prognosis
Address all correspondence to:
Dr. Mitsushige Murata
Department of Laboratory Medicine
Keio University, 35 Shinanomachi, Shinjuku-ku
Tokyo 160-8582, Japan.
Tel: +81-3-5843-6702; Fax: +81-3-5363-3875
E-mail: muratam@a7.keio.jp
Original Article
Effect of lesional differences in prolapsed leaflets on clinical outcomes in
patients with mitral valve prolapsed
Keiko Suzuki, Mitsushige Murata, Risako Yasuda, Hikaru Tsuruta, Naoki Tomotsugu, Takayuki Abe, Shiro Iwanaga, Makoto
Akaishi, Keiichi Fukuda
Department of Cardiology; Department of Laboratory Medicine; Center for Clinical Research, Keio University, School of
Medicine, Tokyo, Japan; Department of Cardiology, Tokyo Medical Universtiy, Tokyo, Japan; Department of Cardiology,
Kitasato University Kitasato Institute Hospital, Tokyo, Japan
Received March 31, 2012; accepted May 27, 2012; Epub July 25, 2012; Published August 15, 2012
Abstract: Background: Mitral valve prolapse (MVP) is usually benign, although serious complications may occur. It remains
unclear whether the region of prolapsed mitral leaflets might affect prognosis. The aim of this study was to investigate
lesional differences of clinical courses of MVP. Methods and Results: We retrospectively investigated 128 MVP patients
who had been followed up for for a mean of 56.4 month. They were classified prolapse of the anterior mitral leaflet (AML, n
= 59), posterior mitral leaflet (PML, n = 47), or both leaflets (AML & PML, n = 22). Echocardiographic and clinical data were
examined from medical records. Average time to clinical events; MV surgery, new onset of atrial fibrillation (AF),
echocardiographic evidence of new chordal rupture, and worsening of mitral regurgitation severity were all significantly
shorter in PML prolapse than in those with AML or AML & PML prolapse. Increases in the left ventricular dimensions and
estimated pulmonary arterial systolic pressures were significantly larger in PML prolapse, compared with AML or AML &
PML prolapses. A subanalysis of PML prolapse revealed that new chordal rupture tended to be more frequent in middle
scallop prolapse cases (48%) compared with lateral and medial scallops (18%). In contrast, new onset of AF tended to
occur in lateral and medial scallop prolapses (44%) compared with middle scallop prolapse (20%). Conclusions: PML
prolapse patients had a poor outcome, compared with AML or AML & PML prolapse patietns. Precise regional evaluation of
the prolapsed leaflets may predict cardiac complications in MVP. (AJCD1203007).
Keywords: Mitral valve prolapse, mitral regurgitation, prognosis
Address all correspondence to:
Dr. Mitsushige Murata
Department of Laboratory Medicine
Keio University, 35 Shinanomachi, Shinjuku-ku
Tokyo 160-8582, Japan.
Tel: +81-3-5843-6702; Fax: +81-3-5363-3875
E-mail: muratam@a7.keio.jp
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