Myxomatous Mitral-Valve Prolapse
A 22-year-old previously healthy man presented to the outpatient clinic with a 6-month history of palpitations and chest discomfort. He reported no history of dyspnea or syncope. The cardiovascular examination was notable for a midsystolic click at the apex. Two-dimensional transthoracic echocardiography revealed a large and thickened anterior mitral-valve leaflet (Panel A) with systolic prolapse of multiple segments into the left atrium (Panel B and video). Annular dilatation and mild mitral regurgitation were present. A diagnosis of myxomatous mitral-valve prolapse was made. Two weeks later, the patient had sudden-onset shortness of breath and presented to the emergency department with acute decompensated heart failure. A repeat echocardiogram showed the presence of severe mitral regurgitation with chordal rupture. He underwent a successful emergency mitral-valve replacement. At follow-up 4 months after surgery, he remained well.
