Mitral valve prolapse in children

Mitral valve prolapse (Angle syndrome, Barlow syndrome, mesosystolic click and late systolic noise syndrome, clapping valve syndrome) - deflection, protrusion of the valve cusps into the cavity of the left atrium during systole of the left ventricle.

Mitral valve prolapse is a widespread pathology of the heart and, in particular, of its valve apparatus.

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What causes mitral valve prolapse in children?

In childhood, mitral valve prolapse is detected in 2.2-14% of children when examined in a population. With organic pathology of the heart, it is found in 10-30% of patients. Mitral valve prolapse can occur in the structure of various diseases, and may be an isolated echocardiographic phenomenon. All variants of mitral valve prolapse are divided into congenital and acquired, primary (isolated, idiopathic) and secondary - as complicated (with rheumatism, carditis) or associated symptom (with heart disease, pericarditis, Marfan disease, Ehlers-Danlos disease, etc.). In children, along with the presence of mitral valve prolapse, small anomalies of development (dysraphic stigmas) are often found, indicating the congenital inferiority of the connective tissue, thus revealing PD. In this case, we are talking about an isolated variant of mitral valve prolapse, since in other cases, mitral valve prolapse is a symptom cardiological disease.

Among the isolated mitral valve prolapses, two forms are distinguished: auscultative (systolic clicks and late systolic murmur) and mute (mitral valve prolapse is detected only during echocardiography).

Currently, it is believed that mitral valve prolapse can occur due to a number of reasons both morphofunctional nature (anomalies of the structure and attachment of the valve apparatus, deformation as a result of inflammatory diseases, etc.), as well as a violation of the vegetative regulation of the leaflets and the subvalvular apparatus in the background psychovegetative syndrome.

Symptoms of mitral valve prolapse in children

Mitral valve prolapse is more often detected in children aged 7-15 years, but can be diagnosed in any year of life.

The auscultatory form of isolated (idiopathic) prolapse is 5-6 times more common in girls. Early history is saturated with pathology of the course. pregnancy, viral infections, threatened abortion. Particularly noteworthy is the unfavorable course of the early antenatal period, i.e. When the structures of the heart and its valve apparatus are differentiated.

In the pedigree of a child with mitral valve prolapse, diseases of the ergotropic circle are often determined in close relatives. The familial nature of mitral valve prolapse was noted in 10–15% of children, moreover, through the mother. The signs of inferiority of the connective tissue (hernia, scoliosis, varicose veins, etc.) can be traced in the proband's pedigree.

The psychosocial environment, as a rule, is unfavorable, often there are conflict situations in the family, at school, which are combined with certain emotional and personal characteristics of the patient (high level of anxiety, neuroticism). Children with mitral valve prolapse are usually distinguished from healthy by a high incidence of acute respiratory viral infections, they often have tonsillitis, chronic tonsillitis.

Among children with isolated mitral valve prolapse, 75% have the following symptoms of mitral valve prolapse: complaints of chest pain, palpitations, a feeling of heart failure, shortness of breath, dizziness. As with all patients with vegetative dystonia, they are characterized by headache, a tendency to fainting. Cardialgia in children with mitral valve prolapse has its own characteristics: they are “stabbing”, “aching”, without irradiation, short-term (seconds, less than a minute), usually occur on the background of emotional stress and are not associated with physical activity. Pain syndrome is stopped by taking sedatives (valerian tincture, valocordin). Dizziness often occurs with a sharp rise in the morning, during long breaks between meals. Headache is more common in the morning, occurs on the background of fatigue, excitement. Children complain of irritability, disturbed night sleep. With orthostatic hypotension, fainting can occur more often on reflex type. The cardiological picture of mitral valve prolapse is diverse and is detailed in the manuals.

Important is the clinical differentiation of mitral valve prolapse variants, which allows to determine the cause and treatment strategy. In addition to cardiological indicators (echocardiography), studies of the autonomic nervous system and the characteristics of the emotional sphere are of great importance.

When examining children with mitral valve prolapse, frequent signs of a dysplastic structure are noteworthy: asthenic physique, flat chest, tall, weak muscle development, increased mobility in small joints, blonde girls and blue-eyed; among other stigmas are determined the gothic palate, flat feet, sandaline slit, myopia, general muscular hypotonia, arachnodactylia; more severe pathology of the musculoskeletal system are funnel chest, straight back syndrome, inguinal, inguinal-scrotal and umbilical hernia.

In the study of the emotional-personal sphere in children with idiopathic mitral valve prolapse, increased anxiety, tearfulness, anxiety, mood swings, hypochondria, fatigue are recorded. These children are characterized by numerous fears (phobias), often the fear of death, if the child develops vegetative paroxysm, which is quite common in such patients. The background of the mood of children with prolapse is changeable, but still there is a tendency to depressive and depressive-hypochondriacal reactions.

The autonomic nervous system is extremely important in the clinical course of mitral valve prolapse; as a rule, sympathicotonia prevails. In some children (more often with a greater degree of prolapse of the cusps) with coarse late-and holosystolic noise, signs of parasympathetic activity can be determined against the background of a high level of catecholamines in terms of cardiointervalography (CIG) and clinical vegetative tables.

In this case, the increase in the tone of the vagus nerve is compensatory in nature. However, the presence of both hypersympathicotonia and hypervigotonia creates conditions for the emergence of life-threatening arrhythmias.

Three clinical variants of the auscultatory form of mitral valve prolapse were identified depending on the severity of the course. In the first clinical case, isolated clicks are determined during auscultation. Small developmental abnormalities are few. Vegetative tone is characterized as hypersympathicotonia, asympathicotonic reactivity. Vegetative activity is redundant. In general, there is a worsening adaptation of the cardiovascular system to the load. In the second clinical variant of mitral valve prolapse has the most typical manifestations. The echocardiogram shows late systolic prolapse of the valves of moderate depth (5-7 mm). The status prevails sympathicotonic orientation of vegetative changes. Vegetative reactivity is hypersympathicotonic, vegetative provision of activity is excessive. In the third clinical variant of the auscultative mitral valve prolapse, pronounced deviations in the clinical and instrumental indices are detected. In the status - a high level of small anomalies of development, with auscultation - isolated late systolic noise. On the echocardiogram is determined Late systolic or holosystolic prolapse of the mitral valve of a great depth. In the study of autonomic tone is determined by the predominance of the effects of the parasympathetic division of the autonomic nervous system, or a mixed tone. Vegetative reactivity is increased, hypersympathicotonic nature, the activity is redundant. These patients have the lowest rates of physical performance and have the most maladaptive reactions of the cardiovascular system to the load.

Thus, the degree of dysfunction of the valvular apparatus of the heart is directly dependent on the severity of the course of vegetative dystonia.

Silent form of mitral valve prolapse is very common, occurs equally often in girls and boys. Early history is also burdened by perinatal pathology, frequent acute respiratory viral infections, which further contributes to the development of vegetative dystonia and dysfunction of the mitral valve.

Complaints and changes on the ECG in many cases are absent - these are practically healthy children. If there are various complaints (fatigue, irritability, pain in the head, abdomen, heart, etc.), the detection of mitral valve prolapse confirms the presence of vegetative dystonia syndrome. In most children, the number of minor developmental anomalies does not exceed 5 or there is a moderate increase in stigmatization (high growth, gothic palate, “loosening” of joints, flat feet, etc.), which in combination with proportional physical development indicates an insignificant role of constitutional factors in the onset of prolapse valves in children with mute form of mitral valve prolapse.

The state of the autonomic nervous system in children with a mute form of prolapse is most often characterized by vegetative lability, less often there is dystonia of parasympathetic or mixed type. Panic attacks in children with mitral valve prolapse occur no more often than in other groups, and if they occur relatively rarely, they do not have a significant effect on the life and well-being of children with mitral valve prolapse.

The vegetative provision of activity in these patients is more often normal, less often inadequate (the hyperdiastolic variant of the clinoroortal). When conducting ergometry, the indicators of physical performance and work performed with silent mitral valve prolapse differ little from the norm compared with these indicators with an auscultative form of mitral valve prolapse.

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Treatment of mitral valve prolapse in children

The main treatment for mitral valve prolapse is compliance with the regimen. Children with silent variants of mitral valve prolapse, who do not have disturbances in the process of repolarization on the ECG, can engage in sports and physical education without any restrictions. In other cases, these issues are resolved by a cardiorheumatologist after examining each patient individually. Treatment of vegetative dystonia is carried out according to the general rules.

What is the prognosis of mitral valve prolapse in children?

Mitral valve prolapse usually has a good prognosis. Pediatricians often exaggerate the prognostic significance and danger of this syndrome for the health and life of people. Only children with a complete symptom complex (the so-called third clinical variant of auscultative mitral valve prolapse) need therapeutic and recreational activities, an ECG, echocardiography 2-3 times a year with the advice of a neurologist and psychologist. In the first, second and intermediate variants of silent prolapse of the mitral valve, a clinical examination is carried out 2 times a year. In the mute form of mitral valve prolapse, it is advisable to show the child to the doctor once a year with echocardiography.