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Implications of mitral valve prolapse in children with rheumatic mitral regurgitation
1Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, Republic of China.
Insights
Children with mitral valve prolapse and rheumatic mitral regurgitation face a poorer long-term prognosis. Mitral valve prolapse is associated with persistent murmurs and increased need for surgery in these pediatric patients.
Area of Science:
- Pediatric Cardiology
- Rheumatic Heart Disease
- Echocardiography
Background:
- Rheumatic fever can cause mitral valve prolapse (MVP), potentially leading to severe mitral regurgitation.
- The impact of MVP on the prognosis of rheumatic mitral regurgitation (RMR) in children is not well understood.
- Early identification and management are crucial for children with RMR.
Purpose of the Study:
- To determine the long-term prognosis of children diagnosed with mitral valve prolapse (MVP) in association with isolated rheumatic mitral regurgitation (RMR).
- To investigate the influence of MVP on the clinical course and outcomes of pediatric RMR patients.
Main Methods:
- A cohort of 181 children diagnosed with rheumatic fever (RF) between 1971-1991 was studied.
- 123 children with isolated mitral regurgitation were assessed for mitral valve prolapse (MVP) using echocardiography.
- Kaplan-Meier survival analysis was used to evaluate event-free rates for murmur persistence, cardiac improvement, and surgical intervention.
Main Results:
- Mitral valve prolapse (MVP) was identified in 30% of pediatric patients with isolated rheumatic mitral regurgitation (RMR).
- Patients with MVP exhibited larger cardiac dimensions during the active rheumatic fever stage.
- MVP was significantly associated with a higher likelihood of persistent murmur and the need for surgical intervention, even after excluding heart failure cases.
Conclusions:
- The presence of mitral valve prolapse (MVP) in children with isolated rheumatic mitral regurgitation (RMR) is a predictor of a less favorable long-term outcome.
- MVP may indicate a higher risk for persistent symptoms and surgical necessity in this pediatric population.
- Further research is warranted to explore specific management strategies for pediatric RMR patients with MVP.
Objectives:
This study was conducted to determine the longterm prognosis of children with mitral valve prolapse associated with isolated rheumatic mitral regurgitation.
Background:
Rheumatic fever may result in mitral valve prolapse, which sometimes leads to severe mitral regurgitation requiring surgical intervention during the active stage of rheumatic fever. However, the influence of mitral valve prolapse on the prognosis of patients with rheumatic mitral regurgitation remains largely unknown.
Methods:
From 1971 to 1991, 181 children who fulfilled the revised Jones criteria of rheumatic fever were identified from a rheumatic fever prevention program. Of the 181 patients, isolated mitral regurgitation was diagnosed in 123 at age 4 to 12 years. The diagnosis of mitral valve prolapse was based on echocardiographic findings. Actuarial event-free curves for persistent murmur, cardiac improvement and surgical intervention were drawn according to the Kaplan-Meier nonparametric estimation.
Results:
Evidence of mitral valve prolapse was shown in 37 (30%) of the 123 patients. Patients with mitral valve prolapse were more likely to have a larger cardiac size than those without mitral valve prolapse during the active stage of rheumatic fever. Although the cardiac status of patients with mitral valve prolapse may improve under adequate secondary prophylaxis, an actuarial analysis indicated that patients with mitral valve prolapse had a greater likelihood of murmur persistence and surgical intervention. This trend toward murmur persistence was observed even when patients with heart failure during the active stage of rheumatic fever were excluded from analysis.
Conclusions:
The presence of mitral valve prolapse in children with isolated rheumatic mitral regurgitation may predict a less favorable outcome.