Cerebral ischemic attacks as a complication of aortic and mitral valve prolapse.

The high incidence of mitral valve prolapse (MVP) in patients with ischemic attacks is puzzling when compared with the very low incidence of cerebrovascular attacks observed in individuals known to have MVP. Our aim was to determine if it is possible to identify a patient subset with MVP at the highest risk of embolization on the basis of 2D-echocardiographic findings. We compared the echocardiographic picture of a group of 39 patients with MVP and cerebral ischemic attacks (29 TIAs, 10 strokes) in the carotid territory, without any pathological lesions at angiography, with that of a control group of 111 patients with MVP without neurological complications. The two groups were not different for age or sex. Patients with MVP and neurological complications showed a higher prevalence of aortic valve prolapse (62% vs 34%, p less than 0.01), of an association between valvular diffuse thickening and aortic valve prolapse (54% vs 23%, p = 0.001), and of multiple valve prolapse with valvular diffuse thickening (26% vs 7%, p less than 0.01) than those of the control group. This study suggests that in young people cerebral ischemic events could be related to the presence of a combined valve prolapse and to an echocardiographic picture of valve diffuse thickening. These data suggest that in this selected group with multiple valve prolapse and valvar diffuse thickening prophylaxis against embolic events by pharmacological preventive measures should be considered.