| Abstract [eng] |
Mitral valve prolapse is a common pathology with a population prevalence of 2–3 % (1). This disorder generally has a good prognosis (2), however recent observations suggest that sudden cardiac death from ventricular arrhythmias associated with mitral valve prolapse can occur more often, with an estimated annual risk ranging from 0.2 % to 1.9 % (3, 4). Arrhythmic mitral valve prolapse is defined as mitral valve prolapse that is associated with complex ventricular arrhythmias (3). Our clinical report describes a 30-year-old female patient with mitral valve prolapse who experienced sudden cardiac death due to an episode of sustained ventricular tachycardia, despite successful and durable mitral valve repair 15 years ago. Imaging studies of the heart assist to look for markers that help select patients with a higher risk of fatal arrhythmic event (5). Between 33 % and 78 % of the patients with malignant ventricular arrhythmias at risk of sudden cardiac death have been found to have an inverted and biphasic T-wave in the inferior and lateral leads. Signs of left ventricular transmural replacement fibrosis in papillary muscles (88 %) or inferolateral left ventricular basal wall (93 %) (6) and mitral annular disjunction were also found (7). Surgical repair theoretically relieves stretch on the papillary muscles and facilitates ventricular remodelling, leading to reduction in ventricular arrhythmias (8). Catheter ablation using invasive electroanatomic mapping is a promising treatment option for patients with arrhythmic mitral valve prolapse, but the positive effects on patient survival have not yet been well documented (9). Despite some sparse evidence that mitral valve surgery can be beneficial in reducing ventricular arrhythmias especially in younger patients, by demonstrating clinical case report and reviewing available literature we would like to stress importance of risk stratification not only before mitral valve surgery but also after successful mitral valve repair. Keywords: arrhythmic mitral valve prolapse; ventricular arrhythmias; sudden cardiac death; mitral annular disjunction; myocardial fibrosis. |
