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Surgical treatment for chest pain in mitral valve prolapse
Insights
Mitral valve prolapse can cause severe chest pain unresponsive to medication. Surgical valve replacement successfully relieved symptoms in one patient, suggesting a valvular origin for the pain.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Mitral valve prolapse (MVP) is a common condition.
- Chest pain is a frequent symptom of MVP, but its etiology remains debated.
- Medical management for MVP-associated chest pain is often ineffective.
Observation:
- A 40-year-old woman with MVP experienced severe, disabling atypical chest pain.
- Electrocardiogram showed an ischemic pattern, but coronary angiography revealed normal arteries.
- The patient's symptoms persisted despite 30 months of medical therapy, including beta-blockers, calcium antagonists, and nitrites.
Findings:
- Surgical replacement of the prolapsed mitral valve with a xenograft was performed.
- The patient became completely asymptomatic 12 months post-surgery, with a normal ECG and no medication.
- This outcome supports the valvular theory of chest pain in MVP, potentially due to papillary muscle stretching.
Implications:
- Successful surgical intervention for refractory chest pain in MVP is reported for the first time.
- This suggests that in select cases, addressing the valvular defect may be curative.
- Further research into the mechanism of MVP-associated chest pain and surgical outcomes is warranted.
Abstract:
The case of a 40-year-old woman with mitral valve prolapse and severe atypical chest pain is presented. The diagnosis was confirmed by phonocardiographic, echocardiographic, and angiocardiographic studies. The electrocardiogram revealed an ischemic pattern of ST-T on the anterior and inferior wall. Coronary angiographic studies showed normal coronary arteries. The patient's long-standing, prolonged, disabling atypical chest pain could not be relieved with medical therapy, despite the administration of beta-adrenergic blocking agents, calcium antagonists, and short-acting nitrites during a 30-month period. Thus, the prolapsed mitral valve was replaced with a Hancock xenograft. After 12 months the patient is totally free of symptoms, without any treatment and with a normal ECG. This excellent surgical result could be explained on the basis of the valvular theory of chest pain in mitral valve prolapse, suggesting that pain is promoted probably by a regional imbalance between oxygen availability and consumption, because of the excessive papillary muscular stretching produced by the prolapse. To our knowledge, this is the first published report of successful surgical treatment of chest pain in mitral valve prolapse.