The Echocardiographic Spectrum of Mitral Valve (MV) Motion in Children with and without Mitral Valve Prolapse (MVP)

Abstract

Recent concern has been expressed over the sensitivity and specificity of echocardiography for the diagnosis of MVP. Accordingly, the purpose of the present study was to define the single crystal and multiple crystal cross-sectional echo spectrum of mitral valve motion in 68 asymptomatic children (age 3–15 years) without abnormal physical findings who constituted the normal group, and 26 children (age 2–10 years) with physical findings of systolic click murmur (CM). From M-mode echoes, mitral valve systolic posterior motion was defined as minor if it was > 10% of the E-F excursion and significant if it was more than 20%. Mitral valve echoes were evaluated only where anterior and posterior leaflet were simultaneously visualized. Of 45 normal children studied by single crystal echo 9 had minor mid to late systolic dips (MSD) of both leaflets, 3 had minor holosystolic “hammocking” (HH) while 3 patients had significant MSD. These findings represent the normal spectrum of mitral valve motion for M-mode and do not represent MVP. There were no dimensional abnormalities in the normal group. Real time cross-sectional studies on 23 normal patients demonstrated a spectrum of mitral valve motion in which the bodies of the anterior and posterior leaflets (defined as that portion of the leaflets occupying a distance halfway between the free edge and the annular insertions) become horizontal with systolic ejection as the aortic root moves anteriorly and the posterior atrio-ventricular junction moves inferiorly.