Evaluating the frequency of mitral valve prolapsus in patients with scoliosis

The association between mitral valve prolapse (MVP) and skeletal deformities, scoliosis in particular, has been demonstrated in several studies. Recognizing the frequency of MVP in patients with scoliosis, determining the presence of MVP and other co-existing valvular heart disease preoperatively is of utmost importance in the follow-up of these patients, and prevention from complications. In this study, the frequency of MVP and other associated cardiovascular abnormalities were evaluated by clinical findings and echocardiography in patients with scoliosis.The study group consisted of 100 patients (60 girls and 40 boys) with scoliosis, aged 1 17 years; the control group consisted of 100 healthy children (56 girls and 44 boys) aged 1 17 years. History, physical examination, electrocardiographic and echocardiographic findings were evaluated in both groups. The diagnosis of MVP was based on visualization of the superior motion of either one or both mitral leaflets above the mitral annular plane in systole by two-dimensional echocardiography in the parasternal long-axis view.The frequency of MVP was 37% in the study (scoliosis) group, and 8% in the control group (p<0,05). 96,4% of the patients with MVP in the scoliosis group were asymptomatic, and characteristic auscultatory findings of MVP were found in 27% of these patients. Further evaluation of the echocardiographic morphology of the mitral leaflets revealed that 68,8% of the patients with MVP were of the straightened leaflet subtype, this being the most common subtype of MVP in both study (scoliosis) and control groups. The age, body weight and height of patients with scoliosis and MVP were greater than those without MVP (15,2±2,8 years vs 13,3±4,1 years, p<0,05; 38,8±11,4 kg vs 30,9±14,1 kg, p<0,05; 148,9±16,3 cm vs 127,7±27,9 cm, p<0,05 respectively); however, no difference was detected in the body mass index (BMI) values between patients with or without MVP. No significant differences regarding heart rate, systolic and diastolic blood pressures, frequency of heart murmurs or abnormal ECG findings were documented between patients with or without MVP in the study (scoliosis) group.Mitral regurgitation (MR), aortic valve prolapse (AVP) and aortic regurgitation (AR) were more frequent in the study group compared to the control group (p<0,05). Left ventricular end-systolic and end-diastolic diameters were significantly higher in scoliotic patients without MVP compared to those with MVP, due to the presence of markedly increased values in 2 patients in the former group (2,35±0,77 cm/m2 vs 2,03±0,37 cm/m2, p<0,05; 3,85±1,22 cm/m2 vs 3,32±0,65 cm/m, p<0,05 respectively).The findings of this study document that the frequency of MVP and other valvular heart disease such as MR, AVP and AR is higher in scoliotic patients compared to controls, hence the cardiovascular system should be carefully evaluated preoperatively in patients with scoliosis. Since MVP is frequent even in asymptomatic scoliotic patients without typical auscultatory findings or ECG abnormalities, echocardiographic screening for MVP should be performed in all patients albeit the absence of significant signs or symptoms.