Skip to main content
Log in

Reduction in malignant ventricular arrhythmia and appropriate shocks following surgical correction of bileaflet mitral valve prolapse

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Bileaflet mitral valve prolapse (MVP) can be associated with malignant ventricular arrhythmias. It is unknown whether surgical correction alone of this mitral valve pathology leads to a reduction in ventricular dysrhythmias.

Methods

We retrospectively analyzed 4477 patients who underwent mitral valve surgery from 1993–2013 at Mayo Clinic in Rochester, MN. Among these, eight patients with bileaflet MVP who had an internal cardioverter defibrillator (ICD) in place both pre- and post-surgery were identified. ICD interrogation records were evaluated for episodes of ventricular tachycardia (VT), ventricular fibrillation (VF), and appropriate ICD shock therapy.

Results

Of these eight patients, five had a malignant ventricular arrhythmia prior to surgery. Data was available 4.6 ± 2.9 years before versus 6.6 ± 4.2 years following surgical intervention. Among these patients, there was a reduction in VF (0.6 versus 0.14 events per-person-year pre- and post-surgery, respectively), VT (0.4 versus 0.05 events per-person-year pre- and post-surgery, respectively), and ICD shocks (0.95 versus 0.19 events per-person-year pre- and post-surgery) following mitral valve surgery.

Conclusions

We report a series of cases where the surgical correction of bileaflet MVP alone was associated with a reduction in malignant arrhythmia and appropriate shocks. These early observations merit further investigation involving larger cohorts to further evaluate the association between abnormal mechanical forces in degenerative mitral valve disease and ventricular dysrhythmias.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

biMVP:

Bileaflet mitral valve prolapse

EMR:

Electronic medical record

ICD:

Implantable cardioverter defibrillator

OHCA:

Out of hospital cardiac arrest

MVP:

Mitral valve prolapse

PVC:

Premature ventricular contraction

SCD:

Sudden cardiac death

VF:

Ventricular fibrillation

VT:

Ventricular tachycardia

References

  1. Delling, F. N., & Vasan, R. S. (2014). Epidemiology and pathophysiology of mitral valve prolapse: new insights into disease progression, genetics, and molecular basis. Circulation, 129(21), 2158–2170.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Freed, L. A., Levy, D., Levine, R. A., Larson, M. G., Evans, J. C., Fuller, D. L., et al. (1999). Prevalence and clinical outcome of mitral-valve prolapse. The New England Journal of Medicine, 341(1), 1–7.

    Article  CAS  PubMed  Google Scholar 

  3. Anders, S., Said, S., Schulz, F., & Puschel, K. (2007). Mitral valve prolapse syndrome as cause of sudden death in young adults. Forensic Science International, 171(2–3), 127–130.

    Article  PubMed  Google Scholar 

  4. Duren, D. R., Becker, A. E., & Dunning, A. J. (1988). Long-term follow-up of idiopathic mitral valve prolapse in 300 patients: a prospective study. Journal of the American College of Cardiology, 11(1), 42–47.

    Article  CAS  PubMed  Google Scholar 

  5. Knackstedt, C., Mischke, K., Schimpf, T., Neef, P., & Schauerte, P. (2007). Ventricular fibrillation due to severe mitral valve prolapse. International Journal of Cardiology, 116(3), e101–e102.

    Article  PubMed  Google Scholar 

  6. Vohra, J., Sathe, S., Warren, R., Tatoulis, J., & Hunt, D. (1993). Malignant ventricular arrhythmias in patients with mitral valve prolapse and mild mitral regurgitation. Pacing and Clinical Electrophysiology, 16(3 Pt 1), 387–393.

    Article  CAS  PubMed  Google Scholar 

  7. Dollar, A. L., & Roberts, W. C. (1991). Morphologic comparison of patients with mitral valve prolapse who died suddenly with patients who died from severe valvular dysfunction or other conditions. Journal of the American College of Cardiology, 17(4), 921–931.

    Article  CAS  PubMed  Google Scholar 

  8. Boudoulas, H., Schaal, S. F., Stang, J. M., Fontana, M. E., Kolibash, A. J., & Wooley, C. F. (1990). Mitral valve prolapse: cardiac arrest with long-term survival. International Journal of Cardiology, 26(1), 37–44.

    Article  CAS  PubMed  Google Scholar 

  9. Sriram, C. S., Syed, F. F., Ferguson, M. E., Johnson, J. N., Enriquez-Sarano, M., Cetta, F., et al. (2013). Malignant bileaflet mitral valve prolapse syndrome in patients with otherwise idiopathic out-of-hospital cardiac arrest. Journal of the American College of Cardiology, 62(3), 222–230.

    Article  PubMed  Google Scholar 

  10. Nishimura, R. A., McGoon, M. D., Shub, C., Miller, F. A., Jr., Ilstrup, D. M., & Tajik, A. J. (1985). Echocardiographically documented mitral-valve prolapse. long-term follow-up of 237 patients. The New England Journal of Medicine, 313(21), 1305–1309.

    Article  CAS  PubMed  Google Scholar 

  11. Chesler, E., King, R. A., & Edwards, J. E. (1983). The myxomatous mitral valve and sudden death. Circulation, 67(3), 632–639.

    Article  CAS  PubMed  Google Scholar 

  12. Franz, M. R. (1996). Mechano-electrical feedback in ventricular myocardium. Cardiovascular Research, 32(1), 15–24.

    Article  CAS  PubMed  Google Scholar 

  13. Wang, Z., Taylor, L. K., Denney, W. D., & Hansen, D. E. (1994). Initiation of ventricular extrasystoles by myocardial stretch in chronically dilated and failing canine left ventricle. Circulation, 90(4), 2022–2031.

    Article  CAS  PubMed  Google Scholar 

  14. Han, Y., Peters, D. C., Salton, C. J., Bzymek, D., Nezafat, R., Goddu, B., et al. (2008). Cardiovascular magnetic resonance characterization of mitral valve prolapse. JACC. Cardiovascular Imaging, 1(3), 294–303.

    Article  PubMed  Google Scholar 

  15. Basso, C., Perazzolo Marra, M., Rizzo, S., De Lazzari, M., Giorgi, B., Cipriani, A., et al. (2015). Arrhythmic mitral valve prolapse and sudden cardiac death. Circulation, 132, 556–566.

    Article  PubMed  Google Scholar 

  16. Noseworthy, P. A., & Asirvatham, S. J. (2015). The knot that binds mitral valve prolapse and sudden cardiac death. Circulation, 132, 551–552.

    Article  PubMed  Google Scholar 

  17. Reece, I. J., Cooley, D. A., Painvin, G. A., Okereke, O. U., Powers, P. L., Pechacek, L. W., et al. (1985). Surgical treatment of mitral systolic click syndrome: results in 37 patients. The Annals of Thoracic Surgery, 39(2), 155–158.

    Article  CAS  PubMed  Google Scholar 

  18. Ross, A., DeWeese, J. A., & Yu, P. N. (1978). Refractory ventricular arrhythmias in a patient with mitral valve prolapse. Successful control with mitral valve replacement. Journal of Electrocardiology, 11(3), 289–295.

    Article  CAS  PubMed  Google Scholar 

  19. Pocock, W. A., Barlow, J. B., Marcus, R. H., & Barlow, C. W. (1991). Mitral valvuloplasty for life-threatening ventricular arrhythmias in mitral valve prolapse. American Heart Journal, 121(1 Pt 1), 199–202.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Samuel J. Asirvatham.

Ethics declarations

Financial support

CVD is supported by NIH T32 Training grant no. HL007111.

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vaidya, V.R., DeSimone, C.V., Damle, N. et al. Reduction in malignant ventricular arrhythmia and appropriate shocks following surgical correction of bileaflet mitral valve prolapse. J Interv Card Electrophysiol 46, 137–143 (2016). https://doi.org/10.1007/s10840-015-0090-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-015-0090-5

Keywords

Navigation