Relation Of Papillary Muscle Traction To Autonomic Nervous System Dysfunction As Evaluated By Head Up Tilt Test In Mitral Valve Prolapse

Abstract

Mitral valve prolapse (MVP) is a common clinical syndrome resulting from diverse pathologic mechanisms of the mitral valve apparatus and presenting itself in highly variable ways. Previous angiographic observations in patients with MVP have suggested that superior leaflet displacement results in abnormal superior tension on the papillary muscle tips that causes their superior traction or displacement . It has further been postulated that such tension can potentially affect the mechanical and electrophysiologic function of the left ventricle.

The present study has been conducted on 30 patients with classic MVP , based on the major criteria of MVP diagnosis , and 15 normal subjects as a control group .

Chest X-ray was done for all patients, and thoracic bony deformities were found to be prevalent in 3 patients (10%) . ECG was normal in 83.3% of patients revealing abnormalities in only 16.7% of patients . Echocardiography was done for every case and in this study , papillary muscle traction and leaflet displacement have been described and measured non-invasively by 2-D. echo. Mitral regurgitation was present in 13 patients only (43.3%).

The present study reveals that papillary muscles in normal subjects maintain a relatively constant distance between their tips and the mitral annulus in contrast to what happens in the patients with classic MVP , where the papillary muscle tips move