Circulation, Vol 54, 3-14, Copyright © 1976 by American Heart Association
RB Devereux, JK Perloff, N Reichek and ME Josephson
For half a century the systolic click and late systolic murmur lay dormant
as innocent auscultatory curiosities. The thirteen years since Barlow
related these phenomena to mitral leaflet prolapse have witnessed an
astonishing information explosion. We have sought to bring together the
accumulated data in this review. An Historical Perspective traces the
evolution from the now abandoned "pericardial" or "extracardiac" phases,
through the leafletchordal phase (redundancy), the myocardial phase
(segmental left ventricular contraction abnormalities), to the anular phase
(dilatation and faulty systolic contraction). Functional Anatomy is dealt
with in terms of pathology, pathophysiology, hemodynamics,
angiocardiography, echocardiography, and physical and pharmacological
interventions. Clinical Manifestations are concerned with prevalence,
natural history, symptoms, physical signs, electrocardiographic
abnormalities and roentgen fingings. The four Major Complications- sudden
death, infective endocarditis, spontaneous rupture of chordae tendineae,
and progressive mitral regurgitation- are examined. Associated Cardiac
Diseases, i.e., Marfan's syndrome, ostium secundum atrial septal defect and
atherosclerotic coronary artery disease, are discussed, and a section on
Treatment deals chiefly with prophylaxis for infective endocarditis and the
management of arrhythmias and chest pain. A final section on Evolving
Information considers etiologic concepts, the nature of left ventricular
contration abnormalities, the cause of chest pain, the relationship to
Marfan's syndrome and ostium secundum atrial septal defect, and the effect
of aging and sex differences on leaflet chordal redundancy.
ARTICLES
Mitral valve prolapse
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