Multiple floppy valves: an echocardiographic syndrome

Echocardiograms of 400 patients with mitral valve prolapse examined at the Peter Bent Brigham Hospital between 1974 and 1977 were reviewed. Eleven patients (3 per cent) were found to have prolapse (10 patients) or large excursion of the tricuspid valve (one patient) and large excursion of the aotric valve (four patients) or dilatation of the aotric root (seven patients) in addition to mitral valve prolapse. Two of these 11 patients underwent mitral valve replacement, and myxomatous degeneration of the valves was noted on pathologic examination. Almost half of the patients with multiple floppy valves (five of 11) had symptoms of congestive heart failure. In contrast to reported series of isolated mitral valve prolapse, in which female preponderance has been documented, 10 of the 11 patients were male. The syndrome of multiple floppy valves may represent either a unique entity or a more advanced form of the same process which underlies mitral valve prolapse.