Mitral valve prolapse in children: clinical characteristics of 113 patients Original Article

Abstract

Aim: In our study the purpose is to look over clinical characteristics of children with mitral valve prolapse MVP with the current literature concepts Material and Method: One hundred thirteen cases admitted to Kocaeli University Faculty of Medicine Department of Pediatric Cardiology between April 2005 and March 2009 were evaluated retrospectively regarding their complaints on admission physical examination electrocardiography ECG telecardiography Holter ECG and echocardiography findings Mitral valve prolapse was defined as superior displacement of the mitral leaflets more than 2 mm into the left atrium during the systole Results: The causes in 113 patients with MVP were; Marfan syndrome in six Noonan syndrome in two mucopolysaccaridosis in six and romatizmal carditis in nine patients The remaining were accepted as primary MVP The age of these subjects 59 girls and 31 boys; M F: 1 9 ranged between 2 17 5 years with the mean of 10 2±5 6 years The most frequent causes of referring the children to cardiologist were; cardiac murmur 44 chest pain 25 and feeling of cardiac palpitations 21 Fourty of 90 patients 44 4 were asymptomatic In 20 of patients BMI percentile was lt;5 Eleven percent of patients had thoracic skeletal anomalies A murmur±mid systolic click was detected in 58 In 23 3 routine ECG showed T wave abnormalities Mitral regurgitation was established on echocardiography in 81 1 of patients Familial inheritance of MVP was found only in 3 6 Conclusions: Our results indicate that MVP is not an uncommon disease and it is more common in adolescent girls with asthenic built Mitral valve prolapse should be kept in mind and echocardiography should be performed in the patients with persistant chest pain palpitation and fatigue even if there is not any murmur or click on oscultation Turk Arch Ped 2009; 44: 57 61 Key words: Adolescent children echocardiography mitral valve prolapse

Keywords

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Çocuklarda mitral kapak prolapsusu: 113 olgunun klinik özellikleri Orijinal Araştırma

Öz

Amaç: Bu çalışmada mitral kapak prolapsusu MKP tanısı alan 113 çocuk hasta geriye dönük olarak incelenmiş ve hastalığın klinik özellikleri ayrıntılı olarak değerlendirilerek literatür bilgileri ışında sözkonusu hastalığın gözden geçirilmesi amaçlanmıştır Gereç ve Yöntem: Nisan 2005 Mart 2009 tarihleri arasında Kocaeli Üniversitesi Tıp Fakültesi Çocuk Kardiyoloji Polikliniği’ne başvuran hastalardan MKP tanısı alanlar geriye dönük olarak incelendi Toplam 113 adet MKP tanılı hasta kaydı saptandı Mitrak kapak prolapsusu tanısı için ölçüt olarak; M mode ekokardiyografik incelemede sistolde mitral kapağın 2 mm ve üzerinde sol atriyuma bombeleşmesi kullanıldı Olguların yakınma fizik inceleme elektrokardiyografi EKG telekardiyografi ekokardiyografi etiolojik değerlendirmeleri ve yapıldıysa ritm Holter incelemelerine hastane kayıt dosyalarından ulaşıldı Bulgular: Yüzonüç olgunun etiolojik değerlendirmesinde altı olguda Marfan sendromu iki olguda Noonan sendromu altı olguda mukopolisakkaridoz ve dokuz olguda geçirilmiş akut romatizmal ateş saptandı Geri kalan 90 birincil MKP’li olgunun ortalama tanı yaşı 10 2±5 6 yaş 2 17 5 yaş E:K oranı 1:1 9 59 kız 31 erkek idi Bu olguların en sık başvuru nedenleri üfürüm duyulması 44 göğüs ağrısı 25 ve çarpıntı 21 olarak sıralanıyordu Olguların 44’ü yakınmasızdı Fizik muayenede olguların 20’sinde vücut kitle indeksi persantili 5’in altındaydı Göğüs iskelet bozuklukları 11’inde vardı Olguların 58’inde muayenede üfürüm midsistolik klik duyuldu Yirmibir olguda 23 3 ise EKG de T dalga değişiklikleri saptandı Ekokardiyografik incelemede olguların 81 1’ inde mitral yetersizliğin MKP’ye eşlik ettiği izlendi Aile öykülerinde olguların 3 6’sının birinci derece akrabalarında MKP öyküsü vardı Çıkarımlar: Mitrak kapak prolapsusu ergenlik çağındaki astenik yapılı kız çocuklarında daha sık görülebilen bir kapak hastalığıdır Israr eden göğüs ağrısı çarpıntı ve çabuk yorulma gibi yakınmalar varsa muayenede klik ve üfürüm duyulmasa bile MKP akılda tutulmalı ve ekokardiyografik inceleme yapılmalıdır Türk Ped Arş 2009; 44: 57 61 Anahtar kelimeler: Çocuklar ekokardiyografi ergen mitral kapak prolapsusu

Anahtar Kelimeler

• Çocuklar, ekokardiyografi, ergen, mitral kapak prolapsusu

References

1. Park MK. Pediatric Cardiology for Practitioners. 5th ed. Philadelphia: Mosby, 2008: 398-401.
2. Malcic I, Zavrsnik J, Kancler K, Kokol P. The mitral valve prolapse syndrome in children and adolescents. Lijec Vijesn 1998; 120: 202-9.
3. Kumaki T, Yokota Y, Kaku K, et al. Study on the mitral valve prolapse. I. Incidence in Kobe University students. II. Follow up study. Jpn Circ J 1985; 49: 1307-11.
4. Warth DC, King ME, Cohen JM, et al. Prevalence of mitral valve prolapse in normal children. J Am Coll Cardiol 1985; 5: 1173-7.
5. Freed LA, Levy D, Levine RA, et al. Prevalance and clinical outcome of mitral valve prolapse. N Engl J Med 1999; 31: 1-7.
6. Hepner AD, Kashani MA, Movahed MR. The prevalance of mitral valve prolapse in patients undergoing echocardiography for clinical reason. Int J Cardiol 2007; 123: 55-7.
7. Grau JB, Pireli L, Yu P-J, Galloway AC, Ostrer H. The genetics of
8. mitral valve prolapse. Clin Genet 2007; 72: 288-95.

9. Freed LA, Acierno JS, Dai D, et al. A locus for autosomal dominant mitral valve prolapse on chromosom 11p15.4. Am J Hum Genet 2003; 71: 1551-9.
10. Pasternac A, Tubau JF, Puddu PE, et al. Increased plasma catecholamine levels in patients with symptomatic mitral valve prolapse. Am J Med 1982; 73: 783-90.
11. Gaffney FA, Bastian BC, Lane LB, et al. Abnormal cardiovascular regulation in the mitral valve prolapse syndrome. Am J Cardiol 1983; 52: 316-20.
12. Boudoulas H. Mitral valve prolapse: etiology, clinical presentation and neuroendocrine function. J Heart Valve Dis 1992: 1; 175-88.
13. Davies AO, Mares A, Pool JL, et al. Mitral valve prolapse with symptoms of beta-adrenergic hypersensitivity. Beta 2-adrenergic receptor supercoupling with desensitization on isoproterenol exposure. Am J Med 1987: 82: 193-201.
14. Oki T, Fukuda N, Kawano T, et al. Histopathologic studies in innervation of normal and prolapsed human mitral valves. J Heart Valve Dis 1995; 4: 496-502.
15. Stouffer GA, Sheahan RG, Lenihan DJ, et al. Mitral valve prolapse: a review of the literaure. Am J Med Sci 2001; 321: 401-10.
16. Bhutto ZR, Barnon JT, Liebson PR, et al. Electrocardiographic abnormalities in mitral valve prolapse. Am J Cardiol 1992; 70: 265-6.
17. Yeo TC, Lim MC, Cheng KL, et al. Clinical and echocardiographic features of mitral valve prolapse patients in a local population. Singapore Med J 1996; 37: 143-6.
18. Thiago LC, Broering E, de Patta M, Kowalski ME, Heinzen FC, Thiago LE. Clinical and electrocardiographic aspects of mitral valve prolapse. Arq Bras Cardiol 1989; 53: 247-50.
19. Van Der Ham DP, De Vries JK, Van Der Merwe PL. Mitral valve prolapse: a study of 45 children. Cardiovasc J S Afr 2003; 14: 191-4.
20. Toren P, Eldar S, Cendorf D, et al. The prevalence of mitral valve prolapse in children with anxiety disorders. J Psychiatr Res 1999; 33: 357-61.
21. Hamada T, Koshino Y, Misawa T, Isaki K, Gejyo F. Mitral valve prolapse and autonomic function in panic disorder. Acta Psychiatr Scand 1998; 97: 139-43.
22. Savage DD, Garrison RJ, Devereux RB, et al. Mitral valve prolapse in the general population. 1. Epidemiologic features: the Framingham Study. Am Heart J 1983; 106: 571-6.
23. Colomina MJ, Puig L, Godet C, Villanueva C, Bago J. Prevalence of asymptomatic cardiac valve anomalies in idiopathic scoliosis. Pediatr Cardiol 2002; 23: 426-9.
24. Park JM, Varma SK. Pectus excavatum in children: diagnostic significance for mitral valve prolapse. Indian J Pediatr 1990; 57: 219-22.
25. Ohara N, Mikajima T, Takagi J, Kato H. Mitral valve prolapse in childhood: the incidence and clinical presentations in different age groups. Acta Paediatr Jpn 1991; 33: 467-75.
26. Naçar N, Atalay S, Tutar E, Ekici F. Mitral valv prolapsuslu hastalarda tanı kriterleri ve izlem. Ankara Üni. Tıp Fakültesi Mecmuası 2002; 55: 283-90.
27. Rokicki W, Krzystolik-Ladzinska J, Goc B. Clinical characteristics of primary mitral valve prolapse syndrome in children. Acta Cardiol 1995; 50: 147-53.
28. Zhou LY, Lu K. Inflammatory valvular prolapse produced by acute rheumatic carditis: echocardiographic analysis of 66 cases of acute rheumatic carditis. Int J Cardiol 1997; 58: 175-8.
29. Barletta GA, Gagliardi R, Benvenuti L, Fantini F. Cerebral ischemic attacks as a complication of aortic and mitral valve prolapse. Stroke 1985; 16: 219-23.