901-117 Mitral Valve Prolapse: Is it Associated with Acute Ischemic Neurologic Events?

A high frequency of association has previously been reported between acute ischemic neurological events and mitral valve prolapse (MVP), especially in young patients (<45 years old), primarily based on M-mode scans. Criteria for diagnosing MVP, however, have subsequently changed based on 3D analysis of valve shape and clinical correlations, greatly decreasing its prevalence. It is therefore necessary to reconsider associations previously described using nonspecific M-mode and two-dimensional (2D) echo criteria. We retrospectively reviewed all echo studies performed from 1985 to 1994 in patients <45 years old referred by their physician because of stroke or transient ischemic attack looking for source of embolus. Patients with known or potential sources such as prosthetic heart valves, intracardiac masses, dilated or aneurysmal LV. or congenital heart defects were excluded. MVP was evaluated using 2D echo criteria now widely accepted (in long-axis views, excluding nonspecific anterior leaflet displacement in the 4-chamber view; these criteria correlate with valve dysfunction and valve-related complications).ResultsOf the244 patients evaluated, only3 (1.2%) had MVP(anterior, posterior and bileaflet with thin valves and normal LA size). All 3 patients also had a patent foramen ovale with shunt. Discussion:Earlier studies using less specific M-mode criteria found MVP in up to 40% of young patients with stroke or TIA, but also in 7–21% of otherwise healthy individuals. In contrast, the very low prevalence of MVP in the present group of patients, despite referral for echocardiography (potential bias towards the diagnosis), suggests the association is much smaller, possibly at the level of random association.ConclusionThe linkage of MVP and acute ischemic neurological events in the young,therefore, could not be demonstratedby more recent validated and accepted 2D echo criteria in an echocardiographic referral population