Prevalence of mitral valve prolapse in normal children

Although echocardiography has become the standard noninvasive method of diagnosing mitral valve prolapse, the diagnostic criteria have been established without clearly defining the range of normal patterns for mitral valve closure. The current study reports the analysis of mitral valve closure patterns in 193 children (aged 5 days to 18 years) making scheduled visits for well child care who were screened by history and physical examination to exclude structural heart disease. Mitral valve systolic leaflet position was analyzed for the appearance of any portion of either leaflet superior to the plane of the anulus. Superior systolic motion was noted in 13% of the overall study group; this pattern was uncommon in infants but more frequent in older children, with a prevalence of 35% in the 10 to 18 year age group. There was no statistically significant difference between male and female children at any age. The prevalence of superior systolic motion decreased markedly if consideration was given to its presence in more than one echocardiographic view (1%) or to displacement of the coaptation point of the mitral valve leaflets (0.5%). Superior systolic motion occurs with such frequency in normal children as to call into question the reliability of this pattern of mitral valve closure as a standard for the diagnosis of mitral valve prolapse. More restrictive diagnostic criteria which consider the degree of leaflet displacement or its presence in multiple echocardiographic views may be necessary to identify those subjects whose mitral valve closure patterns truly fall outside the range of normal.