Effects of postural changes on duration and intensity of mitral regurgitation in mitral valve prolapse with 2 –dimensional echocardiography in 10-15 years children

Introduction: MVP (Mi tra l va lve prol apse ) is o ne of the most common psychosom ati c syndromes. It is a lon g time th at the effect of body position on cardiac murmurs is recognized. Althou gh authorities imagined that ausculta to ry findings during postur al cha nges in the patients wit h mit ral valve pro la ps e (MVP) a nd mitr al re gurgi ta t io n (MR) and la te sys to lic murmur (LSM) are associated with more pro lapsing of mit ral valve due to decrease in LV volume in th e sta nding positi on , but this issue is no t analytica lly estim ated . Material and Methods: We stud ied 12 pat ien ts with mea n age of 12± 2 ye ar (yr) (±2SD), me an wei ght was 50 ±6 kg ( ± 2SD) wi th mat ch co ntro lcd pop ulat io n . Ec hoca rd io grap hi c para me ters we re ext ract ed sepa rate ly in supine and s ta nding positi ons : le ft ve n t r icula r e nd di ast olic volu me (LVED V) . left ve nt ri clu la r end sys to lic vo lume (LVESV) . Q-W inte rva l, velocity time intergeration (VTI) , heart rat e (HR). focal dyskinesia of posterior ve nt ricular wall mo tio n and co lo r flow-jet o f MR. LVESV a nd LVEDV used fo r es timat io n o f vo lume t r ic cha nges , like Q-W interval (from Q wave to the beg inning of MR signa l pu lsat io n) for dur a tio n of LSM. VTI (velo city -t ime integrat io n) used for assessmen t of int e nsi fication of the murm ur. Ab normal motio n of ve nt ricu lar wall a t th e level o f ap posi tion o f mitr al le an e ts jus t above papillary muscles for evaluation of focal ventricular wall dyskinesia. Results: Pa tients we re divided into two groups acco rding to the response of postural changes o n duration and inte nsificat ion of the murmur at vario us states : gro up A (respo nde r) 8 pat ients had prolonged duration and inten sificat ion of murmur: gro up B (no n-respo nde r) 4 patients who showed none of these changes (nearly similar findings were o btained in co ntro l populati on ) : HR were significa nt ly increased in responder pati en ts like decrease in the ir LV volume, whe reas no considerable changes in non -respo nder gro up which might be d ue to no effect o n LV vo lume. One ofr e spo nde r group also showed abno rmal poste rio r ve ntr icula r wa ll mot io n (ventricular dyskinesia) but occ urred only in one non -resp onder group (65% again st 25%), that changes o n LV volumes were not co nside rable. The pos tur al cha nges in color Dop pler signa l also co rresponded well with those in murm urs with regard to the duratio n and intensification of re sponder group. We proposed that establishment of focal dyskinesia in responder group could be relate d to the more complex interactions for initi a ti o n of dysk ine sia rather than simple var ia t io n of ventricular volume (a ltho ugh all of them were mild or non -significant). Conclusion: The postural changes in MR of MVP patients from supine to sta nding po sition were great ly de te rmin ed by decrease in LV vo lume which are co rres po nding well wit h the deve lo pment of abnorma l LV posterior wa ll motion ( foc a l ven tr icu la r dyski nesia ) . wh ere as in non -responder group did not occurred because of no affection on LV volumes.