Can MVPS produce diastolic clicks . . . and opening snaps ?
Posted Oct 31 2012 12:01pm
Mitral valve prolapse probably is the most common cause for abnormal added sounds in cardiac auscultation . MVPS occurs when mitral valve tissue and its accessories overgrow disproportionately with reference to the mitral valve orifice (Also referred to elongated or redundant leaflet) .The net mass of mitral valve apparatus has an inverse relationship with LV cavity volume . Because of excess motion , leaflet may bulge into left atrium to different degrees and different angulations. This entity as rule is benign in most people . Still , rampant diagnosis in the community (With the pathological proliferation of scan centers ) has raised considerable anxiety .
Hence , the criteria to diagnose MVPS are made stricter .Unless the leaflets are thickened and some degree of MR occurs the usage of the term MVPS is not justified .
Unusual sounds in MVPS
In many patients , AML become so nimble , it flexes, bends and stretches in both systole and diastole. These leaflets can generate clicks not only during prolapse . Simple folding and unfolding of long redundant is known to produce clicks.
generally folding occurs in diastole and unfolding in systole ( of course in extreme redundancy both can occur in both phases )
This diastolic clicks in MVPS has been reported rarely in literature . It is more common than we realise .The timing of these clicks are not constant .Audibility is low .It can easily be confused with opening snap of mitral stenosis .
The spatial relationship between the sound generation and the anatomical prolapse does not match . It is always possible when PML prolapses AML may generate a click and vise versa . Diastolic clicks or opening snaps are known to occur in some of the severe forms of MVPS. The first heart sound is not only loud , the differential motion AML and PML may distort two componets of M1 .It needs to be emphasized the loudness of S1 can be preserved even in the presence of significant MR .(Even as the PML prolapses causing MR , an elongated AML continues to generate a booming S 1)
Can MVPS produce diastolic added sounds ? Yes . . . it can .
Mid systolic click , and late systolic murmur is the classical manifestation of MVPS . In reality , one can get a variety of noises from prolapsing mitral valve apparatus in both phases of cardiac cycle.
These are all inferred from bed side observation . Luckily I have found a reference from a New york state journal of medicine .Other wise my observations would have been ridiculed . Gone are the days when we spend hours together in clinical auscultation of mitral valve motion .
Today we are in the era , working in hi- tech cath labs , aiming to capture those same redundant mitral leaflets with catheters and clip its wings to reduce the mitral regurgitation .
Asking for a phon0-cardiographic documentation of diastolic mitral click in MVPS would be a laughing stock among current generation cardiologists ! Still I would argue for such a study !