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Mitral valve prolapse in childhood: the incidence and clinical presentations in different age groups
N Ohara1, T Mikajima, J Takagi
1Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan.
Insights
Mitral valve prolapse (MVP) incidence increases with age in children, with higher rates in older groups. Most pediatric MVP cases are asymptomatic, and common arrhythmias like ventricular premature contractions (VPCs) are benign.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Clinical Investigation
Background:
- Mitral valve prolapse (MVP) is a common cardiac condition.
- Understanding its incidence and natural history in children is crucial for diagnosis and management.
- Limited data exists on pediatric MVP prevalence across different age groups.
Purpose of the Study:
- To determine the incidence of mitral valve prolapse (MVP) in children.
- To investigate the natural history and associated symptoms of pediatric MVP.
- To analyze the prevalence of arrhythmias in children diagnosed with MVP.
Main Methods:
- A cohort of 4,238 children aged 1 day to 15 years was studied.
- Two-dimensional echocardiography was used to diagnose MVP in a double-blind manner.
- Holter ECG and exercise stress tests were employed to detect arrhythmias.
Main Results:
- MVP incidence increased with age: 0% in newborns, 0.25% in infants, 2.1% in 6-7 year olds, and 5.1% in 12-15 year olds.
- Arrhythmias, primarily benign ventricular premature contractions (VPCs), were found in 49% of MVP cases.
- Most pediatric MVP cases (77%) were asymptomatic, though symptoms increased with age.
Conclusions:
- The incidence of mitral valve prolapse (MVP) significantly rises throughout childhood.
- Pediatric MVP is often asymptomatic, with benign arrhythmias being common.
- Long-term follow-up into adulthood is recommended for children with MVP.
Abstract:
To elucidate the incidence and natural history of mitral valve prolapse (MVP) during childhood, we investigated a total of 4,238 children (aged from 1 day to 15 years) classified by age into 4 groups: Group 1:1 to 28-day-old full-term normal newborns (n = 108), Group 2: 6 to 18-month-old infants (n = 391), Group 3: 6 to 7-year-old children (n = 2,801), and Group 4: 12 to 15-year-old children (n = 938). The incidence of MVP was determined by videorecorded two-dimensional echocardiography in a double-blind method twice-over. There were 109 cases diagnosed as having MVP. The incidence rates of MVP were as follows: Group 1: 0%, Group 2: 0.25%, Group 3: 2.1% and Group 4: 5.1%. Arrhythmias were detected in 49% (27/55) by Holter ECG, and by exercise stress test in 4.7% (2/43). Eighty-three (77%) of 108 cases in Groups 3 and 4, excluding the 1 case in Group 2, showed no symptoms. Ventricular premature contraction (VPC) was the most common arrhythmia, and was benign in all cases. A mid-systolic click (MSC), late systolic murmur (LSM), MSC + LSM, and a pansystolic murmur were detected in 23.1%, 3.7%, 4.6% and 5.6%, respectively. Symptoms caused by MVP increased and appeared more apparently with age. Further prospective long-term follow-up studies to adulthood are necessary.