Abnormal motion of the mitral valve with pericardial effusion: Pseudo-prolapse of the mitral valve

doi:10.1016/S0002-8703(76)80429-2

American Heart Journal

Volume 91, Issue 1, January 1976, Pages 18-20

https://doi.org/10.1016/S0002-8703(76)80429-2 Get rights and content

Summary

The echocardiograms of seven patients with large pericardial effusions were found to show posterior motion of the mitral leaflets in systole as seen in prolapse of the mitrals valve. Repeat echocardiograms after resolution of the effusion revealed normal mitral valve motion. None of the patients had clinical evidence of prolapsed mitral valve. We postulate that a posterior swing of the heart within the pericardial fluid occurring in late systole causes posterior displacement of the mitral valve simulating a prolapsed valve.

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Cited by (13)

Mitral valve prolapse
1987, Disease-a-Month
Mitral valve prolapse is a common mitral valve disorder manifested clinically as a midsystolic click and/or a late systolic murmur (the click-murmur syndrome) and pathologically as billowing or prolapsing mitral leaflets (the floppy valve syndrome). Not only is it one of the two most common congenital heart diseases and the most common valve disorder diagnosed in the United States, but it is also prevalent throughout the world. Mitral valve prolapse may be associated with a variety of other conditions or diseases. Diagnosis of mitral valve prolapse should be made on clinical grounds and, if necessary, supported by echocardiography. The majority of patients with mitral valve prolapse suffer no serious sequelae. However, major complications such as disabling angina-like chest pains, progressive mitral regurgitation, infective endocardids, thromboembolism, serious arrhythmias, and sudden death may occur. Unless these serious complications occur, most of the patients with mitral valve prolapse need no treatment other than reassurance, including those with atypical chest pain or palpitation unconfirmed by objective data. Therapy with a beta-blocker for disabling chest pain and/or arrhythnnias and antiplatelet therapy for cerebral embolic events may be indicated. In occasional patients with significant mitral regurgitation surgery may be necessary.
Frequency and significance of M-mode echocardiographic evidence of mitral valve prolapse in clinically isolated pure mitral regurgitation: Analysis of 65 patients having mitral valve replacement
1984, The American Journal of Cardiology
To assess the reliability of M-mode echocardiographic patterns of mitral valve prolapse (MVP) (echo MVP) in detection of morphologic evidence of MVP (morphologic MVP), operatively excised mitral valves and corresponding M-mode echocardiograms from 65 patients with chronic, severe, isolated, pure mitral regurgitation (MR) were studied. Of the 65 patients, 45 (69%) had echo MVP (either holosystolic or mid-to-late systolic prolapse patterns on preoperative M-mode echograms) and 42 (93%) of them had morphologic MVP;of the 3 without morphologic MVP, 2 had ruptured chordae tendineae from infective endocarditis and 1 had papillary muscle dysfunction from atherosclerotic coronary heart disease. Of the 20 patients without echo MVP, 14 (70%) had no morphologic MVP (9 had papillary muscle dysfunction from coronary heart disease, 4 had infective endocarditis on previous normal valves and 1 had rheumatic heart disease). Of the 48 patients with morphologic MVP, 42 (88% ) had echo MVP and most had considerably dilated mitral anulae;the other 6 had ruptured chordae tendineae with less degrees of anular dilatation. Of the 17 patients without morphologic MVP, 3 had echo MVP (coronary artery disease in 1 and infective endocarditis on a previous normal valve in 2);of the 14 with neither echo nor morphologic MVP, 9 had papillary muscle dysfunction from coronary artery disease, 4 had infective endocarditis on previously normal valves and 1 had rheumatic heart disease. The patients with very dilated mitral anuli and leaflet areas generally had holosystolic (hammocking) patterns on echo;the patients with small anuli and leaflet areas usually had mid-to-late systolic (buckling) prolapse patterns.
Echocardiography in the diagnosis of idiopathic hypertrophic subaortic stenosis coexisting with pericardial effusion
1979, Chest
Of 89 patients with idiopathic hypertrophic subaortic stenosis who had M-mode echocardiagrams recorded, seven patients with coexisting moderate to large pericardial effusions were identified. The clinical profile, M-mode echocardiograms, and cardiac catheterization and angiocardiographic studies in two of the seven patients were analyzed. That the two entities were not associated was suggested by the identification of an etiology for the pericardial effusion in four of the patients. Although the “swinging heart” phenomenon was exhibited in the echocardiograms of each patient, the presence of a significant pericardial effusion did not preclude the ability to establish a diagnosis of idiopathic hypertrophic subaortic stenosis by M-mode echocardiography.
The mitral valve prolapse syndrome. Spectrum and therapy
1979, Medical Clinics of North America
Echocardiographic evaluation of pericardial diseases
1978, Progress in Cardiovascular Diseases
Unusual echocardiographic manifestation of pericardial fluid
1977, The American Journal of Cardiology

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^*: This work was supported in part by the American Heart Association, Greater Los Angeles Affiliate, Grant 490-1G1.

¹: From the Department of Medicine, University of California School of Medicine, Los Angeles, Calif.

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Abnormal motion of the mitral valve with pericardial effusion: Pseudo-prolapse of the mitral valve*

Summary

Am. J. Cardiol.

Am. Heart J.

Echocardiographic recognition of mitral valve prolapse

Circulation

Echocardiographic patterns in patients with the syndrome of systolic click and late systolic murmur

N. Engl. J. Med.