Sakamoto T
Second Department of Internal Medicine, Faculty of Medicine, University of Tokyo.
J Cardiogr Suppl. 1986(11):5-17.
A short history of mitral valve prolapse was reviewed to learn what was the knowledge we have and to recognize what should be resolved at the present time and in the near future. Particular emphasis was placed on the detailed studies performed in Japan as compared to those of occidental countries. Prevalence of mitral valve prolapse largely depends on the methods of investigation and is definitely related to the diagnostic criteria. Among those, the echocardiographic criteria are particularly important, but there are pitfalls which cause over- or underdiagnosis. Auscultatory criteria, which should be confirmed by phonocardiography, are not sensitive enough because of the presence of "silent" prolapse, though the auscultatory acumen of the averaged doctors is quite often unexpected. DaCosta syndrome and the related conditions have some connections with mitral valve prolapse syndrome. The relation should extensively be studied, because somatic and mental signs are not conclusively related to the anatomical abnormalities and the cases with borderline prolapse tend to have definite signs and symptoms. Natural course of mitral valve prolapse based on the long follow-up study is far from the conclusion. So far, no comprehensive cases with well-known natural history of this entity. Prognosis should be carefully evaluated, because most of the patients are doing well and several ominous prognostic signs, such as sudden deaths, are thought to be overemphasized.
回顾二尖瓣脱垂的简史，以了解我们所掌握的知识，并认清目前及不久的将来需要解决的问题。与西方国家的研究相比，特别强调了在日本进行的详细研究。二尖瓣脱垂的患病率在很大程度上取决于调查方法，并且肯定与诊断标准有关。其中，超声心动图标准尤为重要，但存在导致过度诊断或诊断不足的陷阱。听诊标准虽应由心音图证实，但由于存在“无症状”脱垂，其不够敏感，不过普通医生的听诊敏锐度常常出人意料。达科斯塔综合征及相关病症与二尖瓣脱垂综合征有一定联系。这种关系应进行广泛研究，因为躯体和精神症状与解剖学异常并无确凿关联，且临界脱垂病例往往有明确的体征和症状。基于长期随访研究得出的二尖瓣脱垂自然病程远未得出结论。到目前为止，尚无关于该疾病完整自然病史的综合病例。应仔细评估预后，因为大多数患者情况良好，且一些不祥的预后迹象，如猝死，被认为被过度强调了。
