Evaluation of the development and course of mitral regurgitation in children with mitral valve prolapse

Mitral valve prolapse (MVP) is a valve pathology characterized by the cambering of one or both leaflets from the mitral valve annulus to the left atrium during systole as a result of fibromyxomatous changes in the mitral valve. The echocardiographic incidence of MVP in the general population is between 2% and 3%. Mitral regurgitation (MR) may often accompany patients with MVP In this context, the objective of this study is to evaluate the development and course of mitral regurgitation and to evaluate the frequency of additional cardiac and extracardiac pathological findings accompanying MVP by retrospectively scanning the patients followed up with the diagnosis of MVP based on two-dimensional echocardiography. The study sample consisted of 202 patients who were followed up with the diagnosis of MVP in Gaziantep University Faculty of Medicine, Department of Pediatric Cardiology, between 2011 and 2021. The age and gender information, frequency of additional cardiac and extracardiac pathological findings accompanying MVP and echocardiography reports available in their files were retrospectively scanned and evaluated. The resulting data were analyzed using the SPSS 25.00 software package. The patients included in the study sample at diagnosis were between 7 months and 17 years old. The mean age of the patients at the time of admission to the hospital due to MVP was 8.73±3.81 years. MR was detected in 94.1% of the patients. It was determined that 74.2% of the patients were girls, and 25.8% were boys. There was no significant difference between boys and girls in terms of the incidence of MR. In the follow-up of the patients, it was determined that the severity of MR decreased by 32.6%, increased by 23.7%, and did not change in43.5% of the patients. Additionally, it was determined that 21% and 79% of the patients had mild and acute MVP, respectively. The most common reason for admission was murmur, followed by a history of acute rheumatic fever, Marfan syndrome, palpitations, arthralgia, fever, back pain, chest pain, and pectus excavatum, respectively. On the other hand, the most common additional cardiac disease accompanying MVP was ASD (atrial septal defect), followed by TVP, patent foramen ovale (PFO), and ventricular septal defect (VSD), respectively. The course of MR in MVP patients whose ASD was closed via transcatheter was not significantly different from other MVP patients. There was also no significant relationship between patients' ejection fraction (EF) levels and MR severity. Extracardiac pathologies accompanying patients with MVP, in order of frequency, were determined as Marfan syndrome, mucopolysaccharidosis, diabetes mellitus, Down syndrome, Niemann-Pick disease, pectus excavatum, and growth retardation. The mean age of MVP patients at admission was 8.73±3.81 years. There were three times more girls than boys with MVP in the study sample. MVP was accompanied by MR in 94.1% of the patients. The severity of MR did not change significantly between admission and follow-up. The most common reason for admission was murmur and chest pain, and the most common accompanying additional cardiac findings were ASD and TVP. There was no significant relationship between MR severity and EF level. The most common accompanying extracardiac pathology was found to be the Marfan syndrome. The study's findings indicate that early diagnosis and follow-up of MVP are crucial. Keywords: Mitral valve prolapse, Mitral regurgitation, echocardiography