Marks A R, Choong C Y, Sanfilippo A J, Ferré M, Weyman A E
Cardiac Unit, Massachusetts General Hospital, Boston 02114.
N Engl J Med. 1989 Apr 20;320(16):1031-6. doi: 10.1056/NEJM198904203201602.
Mitral-valve prolapse is a common cardiac valvular disorder with a wide range of severity and diverse clinical outcomes. The lack of a standard definition of mitral-valve prolapse may explain the variation in reported complication rates. To identify high-risk and low-risk subgroups, we retrospectively analyzed clinical and two-dimensional echocardiographic data from 456 patients with mitral-valve prolapse. Mitral-valve prolapse was defined on the basis of echocardiographic findings as systolic displacement into the left atrium of one or both leaflets beyond the plane of the mitral annulus in the parasternal long-axis view. Two groups of patients were compared: those with thickening of the mitral-valve leaflets and redundancy (designated the classic form; n = 319) and those without leaflet thickening (designated the nonclassic form; n = 137). The two groups were similar in age and sex ratio. Complications or a history of complications was more prevalent in the classic than the nonclassic form: infective endocarditis, 3.5 percent and 0 percent, respectively (P less than 0.02); moderate-to-severe mitral regurgitation, 12 percent and 0 percent (P less than 0.001); and the need for mitral-valve replacement, 6.6 percent and 0.7 percent (P less than 0.02). However, the frequency of stroke was similar in the two groups: 7.5 percent and 5.8 percent (P not significant). We conclude that in a selected population of patients with mitral-valve prolapse, those with the classic form (leaflet thickening and redundancy) are at higher risk than those without these features for the infectious and hemodynamic complications of mitral-valve prolapse, but not for stroke.
二尖瓣脱垂是一种常见的心脏瓣膜疾病，严重程度范围广泛，临床结局多样。二尖瓣脱垂缺乏标准定义可能解释了报道的并发症发生率的差异。为了识别高风险和低风险亚组，我们回顾性分析了456例二尖瓣脱垂患者的临床和二维超声心动图数据。根据超声心动图结果，二尖瓣脱垂定义为在胸骨旁长轴视图中，一个或两个瓣叶在收缩期移位到二尖瓣环平面之外进入左心房。比较了两组患者：二尖瓣瓣叶增厚且冗长的患者（称为经典型；n = 319）和无瓣叶增厚的患者（称为非经典型；n = 137）。两组在年龄和性别比例上相似。并发症或并发症病史在经典型中比非经典型更常见：感染性心内膜炎分别为3.5%和0%（P < 0.02）；中重度二尖瓣反流分别为12%和0%（P < 0.001）；二尖瓣置换需求分别为6.6%和0.7%（P < 0.02）。然而，两组中风的发生率相似：分别为7.5%和5.8%（P无统计学意义）。我们得出结论，在选定的二尖瓣脱垂患者人群中，具有经典型（瓣叶增厚且冗长）的患者比没有这些特征的患者发生二尖瓣脱垂的感染性和血流动力学并发症的风险更高，但中风风险并非如此。
