Reversible mitral valve prolapse and mitral regurgitation in children with Graves' disease

Area of Science:

• Pediatric Cardiology
• Endocrinology
• Cardiovascular Medicine

Background:

• The association between mitral valve prolapse (MVP) and hyperthyroidism is known in adults, but long-term prognosis in children with significant mitral regurgitation is unclear.
• Graves' disease, an autoimmune cause of hyperthyroidism, requires careful cardiac evaluation in pediatric patients.

Observation:

• Three pediatric patients with Graves' disease presented with significant mitral regurgitation murmurs and echocardiographic evidence of MVP.
• Clinical manifestations included palpitations, exertional dyspnea, and exercise intolerance, with sinus tachycardia on ECG.
• Exophthalmos was noted in two patients, with cardiac symptoms preceding ocular signs in one.

Findings:

• Cardiac murmurs resolved in all patients following medical control of hyperthyroidism with antithyroid agents.
• Follow-up echocardiography revealed normalization in one patient and mild mitral regurgitation with MVP in two.
• These findings suggest a reversible nature of cardiac involvement in pediatric hyperthyroidism.

Implications:

• Mitral valve prolapse and significant mitral regurgitation can occur in children with hyperthyroidism, especially Graves' disease.
• Prompt diagnosis and effective management of hyperthyroidism are crucial for favorable cardiac outcomes in affected children.
• This study highlights the importance of cardiac monitoring in pediatric hyperthyroidism and suggests a good prognosis with appropriate treatment.