Doctors often diagnose children with mitral valve prolapse, which plunges parents into panic. Dangerous or not? Is this disease treatable? How can it threaten the child in the future?

Let's start with anatomy. The human heart consists of four sections (chambers) - two atria and two ventricles. The atria are separated from the ventricles by valves that allow blood to flow in only one direction - from the atria to the ventricles. The valve located between the left ventricle and the left atrium is called the mitral valve. It consists of two plates - valves. Normally, when the ventricles begin to contract to send blood through the vessels, the mitral valve leaflets close tightly and prevent blood flow from going backward.

But sometimes either one leaflet, or part of it, or both leaflets at once begin to sag, “fall” towards the left atrium. This is called mitral valve prolapse (MVP).

The frequency of MVP in children ranges from 2 to 16% and depends on the method of its detection. The incidence of mitral valve prolapse increases with age. Most often, prolapse is detected at the age of 7-15 years. In children under 10 years of age, prolapse occurs approximately equally often in boys and girls; over 10 years of age, MVP is much more often found in girls in a ratio of 2:1.

Is mitral valve prolapse dangerous?

It all depends on how much the valve leaf sags. With slight valve sagging, people live for many years without limiting themselves in any way. With significant prolapse, the valve ceases to perform its function and a reverse flow of blood occurs from the ventricle into the atrium.

Children with MVP are subject to dispensary observation with regular examination (ECG, EchoCG, etc.).

In childhood, MVP usually progresses favorably. Complications from MVP in children occur quite rarely.

It is possible to develop acute (due to chordal separation, with pulmonary venous hypertension) or chronic mitral regurgitation, infective endocarditis, severe forms of arrhythmias, thromboembolism, sudden death syndrome, most often of an arrhythmogenic nature.

The development of complications, progression of valvular disorders and mitral regurgitation adversely affect the prognosis. MVP that occurs in a child can lead to difficult-to-correct disorders in adulthood. In this regard, timely diagnosis and precise implementation of the necessary therapeutic and preventive measures in childhood are necessary.

Prevention is aimed mainly at preventing the progression of existing valve disease and the occurrence of complications.

The issue of admission to sports is decided individually. In the presence of mitral valve prolapse, it is necessary to take into account family history (cases of sudden death in relatives), the presence of complaints of palpitations, cardialgia, and syncope. Changes in the ECG (heart rhythm disturbances, short and long QT syndrome) are the basis for deciding whether sports training is contraindicated. This also applies to the presence of abnormally located chords and trabeculae with early ventricular excitation syndrome, which, being arrhythmogenic MARS, can provoke cardiac arrhythmias in athletes under conditions of physical and psycho-emotional stress on the valve.

Literature
Diseases: textbook / Ed. A.A. Baranova - 2nd ed., - 2009. - 1008 p. Did you like the article? Share the link

The site administration does not evaluate recommendations and reviews about treatment, drugs and specialists. Remember that the discussion is being conducted not only by doctors, but also by ordinary readers, so some advice may be dangerous to your health. Before any treatment or taking medications, we recommend that you consult a specialist!

COMMENTS

Irina / 2015-03-29

Since childhood, the child had a patent oval window in the heart, then murmurs. Observed, without treatment. In the 4th grade, I simply took her to a cardiologist for a check-up. The child is actively involved in sports, I think it is necessary to be examined. They did an ultrasound of the heart and diagnosed 1st degree mitral valve prolapse. The doctor prescribed Magnirot. In general, we drink 3 times a day.

Lena / 2015-03-29
What about sports? And what sports do you do?

Irina / 2015-03-29
We do taekwondo, they said that for now it’s possible to do sports in our case, but not to the point of fanaticism.

Ira / 2015-03-30

As I understand it, first-degree mitral valve prolapse is not a pathology and no treatment is required. A slight deflection (prolapse) of the mitral valve leaflet occurs very often in practically healthy people. And they live with him and lived before. You can do physical education and sports, there are no contraindications. The widespread detection of MVP in recent years is associated with the widespread use of cardiac ultrasound. There was no ultrasound, there was no prolapse. And most importantly, now there is a reason to treat, especially in private clinics. After all, you need to go every six months for observation.

Our doctor said that the health significance of valve prolapse is determined not so much by its degree as by the degree of mitral regurgitation associated with it. So if your child has been diagnosed with mitral valve prolapse, do not panic ahead of time, consult with a competent specialist

For the first time in 1887, the phenomenon of valve prolapse was described in the form of an audible “click” at the apex of the heart. In 1963, thanks to a cardiographic study, sagging of the mitral valve leaflets into the atrium cavity was revealed.

The frequency of occurrence in children is up to 14% in the population, more common in girls aged 6 to 15 years.

The results of research by the American scientist Framingham showed that heart valve prolapses occur with the same frequency in both boys and girls and do not depend on age categories.

Mitral valve prolapse mainly occurs in children. But also in 4% of cases there may be prolapse of the tricuspid valve, and prolapse of the aortic and pulmonary valves is very rare.

Prolapses are minor cardiac anomalies. Defects include only the development of valve insufficiency, which subsequently requires prosthetics.

What is a valve apparatus?

The heart pumps up to 5 liters of blood per minute. It requires communications between cameras to operate optimally.

Thanks to the valves, blood flows from one chamber to another and does not return back.

The tight closure is caused by the pressure difference. There are four valves in the heart: mitral, tricuspid, aortic, and pulmonary.

The valves are very durable in their structure and can withstand a fairly large volume of blood. During relaxation of the heart chambers, the valves should normally close tightly.

The main reason is changes in the connective tissue, which becomes loose.

As you know, the valve apparatus, chords of the heart, and valve rings consist of it.

Changes in connective tissue structure are determined by:

• congenital pathology or primary prolapse (this type of pathology is called myxomatous degeneration);
• hereditary factor;
• rapid growth spurt;
• additional or extended chords.

It is also very important to find out cardiac pathology in close relatives and exclude so-called cardiomyopathy. This is a disease characterized by early death of cardiac cells, enlargement of the heart cavities and decreased myocardial contractility.

1. Rapid heartbeat, or tachycardia. Appears in a calm state, not accompanied by a feeling of fear and heavy sweat.
2. Headaches, dizziness, more often in the evening.

   Do not allow children to stay near computer monitors or telephones for a long time. This is a huge load on the visual system, which can lead to headaches.

3. Presyncope. Very often, teenagers experience discomfort in stuffy rooms.
4. Pain in the heart, chest. This often happens with prolapses; this is due to the influence of the sympathetic nervous system. The pain intensifies during psycho-emotional stress.
5. Feeling of interruptions in the heart. A feeling of cardiac activity fading, and then an increase or decrease in rhythm.
6. Panic attacks. At the same time, the child suddenly develops a fear of something.
7. Hyperventilation syndrome. This is a feeling of lack of air. As a rule, it is more often observed in impressionable children. When a child begins to worry, an attack of suffocation appears. In this case, it is worth differentiating the state from.
8. Frequent nosebleeds. This is due to the fact that blood clotting is reduced due to the low content of connective tissue fibers.
9. If the prolapse is acquired, it often develops after a sore throat or confirmed rheumatism. May be accompanied by joint pain.

In most cases, mitral valve prolapse can only “give” an auscultatory picture.

This means that the pediatrician will note a murmur or “click” in the heart area when listening to the chest. Moreover, it is better to listen to children with this pathology lying down.

The nervous system is also very important in the occurrence of complaints. The mitral valve has little automaticity, and under the influence of catecholamines (adrenal hormones) produced when the state of the nervous system changes, it can sag.

The nervous system is divided into sympathetic and parasympathetic. When they are imbalanced, complaints arise.

Diagnostics

1. One of the most important examinations is cardiac ultrasound, which gives a complete picture of the anatomical structure of the heart.
2. ECG. Evaluates rhythm and conduction.
3. Blood electrolytes (magnesium, potassium, calcium).
4. General blood and urine analysis.
5. Daily ECG monitoring to detect rhythm and conduction disturbances.
6. ECG stress tests – treadmill test or bicycle ergometry.

Treatment of mitral valve prolapse

Grade 1 prolapse does not need to be treated. Children have no restrictions in playing sports and physical education.

For grade 2 and 3 prolapse, therapy that improves metabolism in the myocardium is indicated.

Cardiotrophic therapy:

• Kudesan. An antioxidant drug, indicated for children from 1 year of age, improves the exchange of microelements in the heart muscle. It has both preventive and therapeutic dosages;
• Elkar. The drug carnitine, a general strengthening drug, stimulates metabolism in the myocardium. Can be prescribed from birth. Improves appetite;
• Riboxin. Vitamin-like drug. Good effect when prescribed to athletes;
• Pantogam. Improves metabolic processes, can lower blood pressure, reduces excitability, improves physical performance and mental activity.

Drugs that improve cerebral circulation:

• Cavinton. Excellent for headaches. Representatives of this group are Oxibral, Cinnarizine;
• magnesium and potassium preparations - Magnelis, Panangin. These medications increase the level of electrolytes important for the heart cell, which improves the rhythm and conductivity of the heart;
• Calcemin. Calcium preparation, strengthens the connective tissue of the valves;
• Omega-3 fatty acids. Have a beneficial effect on heart rate.

  Norwegian scientists have proven that sleep disturbances, irritability, and mood swings are caused by omega-3 deficiency. It is also important to include sea fish and vegetable oils (especially flaxseed) in your diet;

• nootropic drugs (Aminalon, Picamilon, Piracetam, Phezam). Increases the resistance of brain cells to hypoxia.

Basically, it is aimed at regulating the functioning of the nervous system:

1. Valerian rhizome is the best sedative. Strengthens inhibition processes in the cortical structures of the central nervous system. The calming effect occurs on average after 2 weeks. As a rule, sedative therapy is prescribed for at least a month. Herbal medicine should be prescribed in courses, 3 times a year.
2. Lemon juice is useful for strengthening heart tissue. But it should be used carefully if the child is allergic.
3. General tonics: nettle, echinacea, fennel, dandelion, centaury.
4. Stimulants: ginseng, Rhodiola rosea, Schisandra chinensis.
5. Physiotherapeutic procedures. Electrosleep, electrophoresis on the cervical-collar area, galvanization - all this promotes muscle relaxation.
6. Don't forget about lifestyle adjustments. The most important thing for children is physical activity. It helps strengthen the muscular framework and connective tissue of the heart valve apparatus. Exhaustive loads are not necessary. Even morning exercises for 15 - 30 minutes a day, outdoor games are great. Cycling and skiing provide good dynamic load.
7. It is also important to create psychological comfort for the child in the family. After all, in fact, with the right attitude towards your baby, this will help maintain the balance of the nervous system, and therefore avoid many problems.

As a conclusion

Mitral valve prolapse can resolve on its own due to changes in the constitutional characteristics of the child. For example, if the baby was tall and thin, but then gained weight, the valve can return to its previous structure.

In this article we examined the cause and treatment of prolapse. We can conclude that prolapse of the valves of the first degree can be classified as a borderline health condition. And timely treatment will prevent the progression of the negative condition.

I don’t understand at all the indignation of mothers about the fact that they are not allowed to breastfeed their children in a public place. For a minute, they don’t let you feed, but they don’t let you expose your breasts. Of course, a hungry child has the right to satisfy his hunger at any time convenient for him, and his mother has the right to feed her child where and when she sees fit. But why do you need to demonstratively expose your breasts? If you are a nursing mother, you probably assume that the time will inevitably come to feed your baby, so take with you a cape, a scarf, a snood, and at least a fan, well, something to cover yourself if necessary. In the end, if it just so happens that you don’t have anything on you, step aside, turn away, choose a place that is not so crowded, so that you don’t embarrass yourself and don’t embarrass people. As for the specific situation in the museum, the issue, in my opinion, is controversial. Here, oddly enough, I am on my mother’s side. Simply because there is absolutely nothing to argue with her. Indeed, what kind of indecency can we talk about in connection with the exposure of the chest if families with children come to the Tretyakov Gallery and do not turn away in embarrassment from the paintings of Rembrandt, Michelangelo’s David without a fig leaf, do not cover the children’s eyes, etc. But this is done as trolling, to annoy the museum administration and the public. In general, I would not drag an infant into a public place during the SARS season, and then, if the incident took place in the Tretyakov Gallery, then sometimes there are such queues at the box office, sometimes you can stand on the street for an hour. Why torture a child? And then it would be possible to step aside again, why feed the baby ostentatiously in a crowd of people? Feeding babies is such an intimate moment that does not tolerate extraneous glances, strangers, not always positive thoughts, etc. But this, of course, is a personal matter for everyone. I don’t know all the details, but if I were the museum staff, I would never have started a scandal with a nursing mother, and if her behavior, in their opinion, somehow violated the order established in the museum, I would (if I were an employee) offered her stole, scarf, or would take her to a more secluded place. Well, if a nursing mother began to make a scandal in response to my (as a museum employee) proposals, defending her rights, I would leave her alone. Why take a sin on your soul, get into a quarrel with it, make it nervous, in the end, everything will affect the baby, it turns out that by your actions you are harming the baby, why is this?

Bulging of the atrioventricular valve leaflets into the cavity of the left atrium during contraction of the left ventricle. Clinical manifestations of mitral valve prolapse include fatigue, dizziness and fainting, cardialgia, palpitations and interruptions in heart function. The diagnosis of mitral valve prolapse in children is established by a pediatric cardiologist taking into account X-ray data, ECG, and EchoCG. Therapeutic tactics for mitral valve prolapse in children involve limiting physical activity, individual exercise therapy, and symptomatic therapy; in case of severe mitral insufficiency - valve repair or replacement.

General information

Mitral valve prolapse in children is a violation of the closing function of the atrioventricular (mitral) valve during left ventricular systole, leading to prolapse of its valves into the cavity of the left atrium. The incidence of mitral valve prolapse in children and adolescents is 2-16%; Moreover, at the age of over 10 years, heart disease is found 2 times more often in girls.

Taking into account objective data, it is customary to distinguish between “silent” and auscultatory forms of the defect. The "silent" form is discovered incidentally during echocardiography; auscultatory - by identifying systolic sound phenomena (mid-systolic clicks, mid-systolic, telesystolic or holosystolic murmurs) by listening to the heart or phonocardiography.

With this form of valve anomaly, the anterior, posterior, or both leaflets of the mitral valve may prolapse. There are 3 degrees of severity of bulging of the mitral valve leaflets: I - from 3 to 6 mm; II - from 6 to 9 mm; III - more than 9 mm. According to clinical manifestations, mitral valve prolapse in children can be asymptomatic, minimally symptomatic and clinically significant.

With mitral valve prolapse in children, the following values ​​of systolic regurgitation may occur:

1. regurgitation in the mitral valve area
2. regurgitation extends to 1/3 of the left atrium cavity
3. regurgitation extends to 1/2 of the left atrium cavity
4. regurgitation extends to more than half the volume of the left atrium cavity.

Reasons

In the development of primary forms of mitral valve prolapse in children, the leading role belongs to connective tissue dysplasia. At the same time, children have various microanomalies of the valve apparatus (changes in the structure of the papillary muscles, size, attachment and number of chords, etc.). The development of connective tissue dysplasia is greatly facilitated by metabolic disorders, magnesium and zinc deficiency, gestosis and infections of the pregnant woman, environmental problems, and heredity.

The causes of secondary mitral valve prolapse in children are varied. First of all, it should be noted the role of hereditary diseases (Marfan syndrome, Ehlers-Danlos syndrome, osteogenesis imperfecta, etc.), which are accompanied by the accumulation of acidic mucopolysaccharides in the valve stroma, myxomatous degeneration of the leaflets and chords, and dilatation of the atrioventricular ring. Mitral valve prolapse in children can be a complication of various diseases: rheumatism, non-rheumatic carditis, infective endocarditis, heart trauma, cardiomyopathy. myocarditis, arrhythmia, pericarditis.

Often, mitral valve prolapse is a consequence of other congenital heart diseases in children that contribute to changes in the hemodynamics of the left heart - atrial septal defect, ventricular septal defect, abnormal drainage of the pulmonary veins, open atrioventricular canal.

In addition, mitral valve prolapse in children may be caused by neuroendocrine, psycho-emotional, and metabolic dysfunction that disrupts the autonomic innervation of the valve apparatus. This condition can be a consequence of neuroses, vegetative-vascular dystonia, thyrotoxicosis, etc.

Symptoms of mitral valve prolapse in children

Manifestations of mitral valve prolapse in children can be highly variable and nonspecific. Most children complain of weakness, poor exercise tolerance, dizziness, headaches, shortness of breath, and sleep disturbances. Cardialgia, tachycardia, sensations of interruptions in the functioning of the heart, arterial hypotension, and a tendency to syncope are often observed. Characteristic psycho-vegetative disorders are asthenia, unreasonable fears, increased anxiety, psychomotor excitability.

Many children with mitral valve prolapse have various types of dysplastic stigmas: “Gothic” palate, hip dysplasia, inguinal and umbilical hernias, postural disorders, chest deformity, hallux valgus, flat feet, early osteochondrosis, stretch marks on the skin, myopia, nephroptosis etc.

With secondary mitral valve prolapse, the symptoms of the leading disease come to the fore. Complications of mitral valve prolapse in children can include chord separation, perforation of the valve leaflet, rhythm disturbances, bacterial endocarditis, heart failure, thromboembolism, sudden cardiac death syndrome, etc.

Diagnostics

The presence of mitral valve prolapse in a child can be suspected by a pediatrician or pediatric cardiologist on the basis of a typical auscultatory triad: the presence of clicks (clicks), characteristic noises and a “chordal squeak”. Phonocardiography helps to correctly assess the nature of heart murmurs.

Instrumental examination of children with mitral valve prolapse includes electrocardiography, cardiac radiography, and echocardiography. An ECG in a child usually shows rhythm and conduction disturbances (right bundle branch block, sinus tachycardia or bradycardia, extrasystole, etc.). In this case, electrocardiographic abnormalities can be detected both at rest and during an orthostatic test or the process of Holter monitoring.

Doppler echocardiography in children with mitral valve prolapse reveals changes in the structure of the valve and subvalvular apparatus, allows one to assess the degree of leaflet prolapse, the severity of regurgitation and the degree of hemodynamic impairment. On radiographs, the size of the heart is not changed or reduced, the arch of the pulmonary artery is moderately bulging, which indicates the inferiority of the connective tissue.

Differential diagnosis of mitral valve prolapse in children is carried out with mitral regurgitation, aneurysm of the interatrial septum.

Treatment of mitral valve prolapse in children

With asymptomatic mitral valve prolapse, children do not need special treatment. In this case, it is enough to limit ourselves to general measures: normalizing the daily routine, alternating mental and physical activity, etc. If mitral regurgitation and rhythm disturbances are detected, it is necessary to limit physical activity with the appointment of an individual exercise therapy complex.

For mitral valve prolapse in children, mainly symptomatic treatment is carried out. Thus, for autonomic disorders, sedatives are prescribed; physiotherapeutic procedures (galvanization, electrophoresis, darsonvalization, massage).

Disorders of repolarization of the ventricular myocardium serve as the basis for cardiotrophic and metabolic therapy (inosine, potassium and magnesium aspartate, B vitamins, L-carnitine, etc.). In case of rhythm disturbances, it is advisable to use β-blockers (atenolol, propranolol) and other antiarrhythmic drugs.

In order to prevent the development of infective endocarditis, antibacterial and immunomodulatory therapy is prescribed before and after minor surgical interventions.

In case of clinically significant mitral regurgitation, as well as a complicated course of mitral valve prolapse, children should be consulted by a cardiac surgeon to decide on the issue of surgical correction of the defect - plastic surgery or mitral valve replacement.

Forecast and prevention of mitral valve prolapse in children

In childhood, mitral valve prolapse is usually benign; complications are rare. Lack of proper treatment and monitoring can lead to the progression of valvular insufficiency and mitral regurgitation, and the development of difficult-to-correct disorders in adulthood. That is why timely diagnosis and treatment and preventive measures are so important in childhood.

Preventive measures mainly come down to preventing the progression of valvular disorders and the development of complications. Children with mitral valve prolapse need selection of individual physical activity and treatment of concomitant heart pathology; clinical observation of a pediatrician, cardiologist and pediatric rheumatologist, pediatric neurologist; regular ECG, echocardiography, etc.