mitral valve regurgitation

[Tlennon]

6 yr old daughter scheduled for open-heart surgery to repair moderate to severe mv regurg ..only diagnosed last year + only discovered during routine exam- no symptoms although smaller than average ..do you think there is a link to anxiousness and mvp/regurg as she tends to get over-whelmed and cries at sometimes small things like forgetting her pencil etc Also what could have caused it ..i had very healthy pregnancy/natural delivery although given high doses of pitocin to speed up birth,  had wisdom tooth infection/extraction in last few days of pregnancy, other than that nothing out of the ordinary.  If congenital wouldn't it have manifested during her baby/toddler years when she was seen by pediatrician a lot in particular first year of life with recurrent ear infections ..she always spiked very high temps, highest was 106 after vaccinations but ped assured me it wasn't vaccine that caused it! I also have older son and younger daughter and so far they are fine, taller than average..thanks, TL from Ireland

[Jeffrey R Boris, M.D.]

Dear T Lennon,

Despite the history that you are giving me about your daughter, it is difficult to actually know the etiology of her mitral valve regurgitation without also looking at her valve by echocardiography.  It is certainly possible that she had a congenital abnormality of the valve that may not have been heard, or may have been milder with subsequent progression over time.  Certainly, she could have had endocarditis, which is an infection of the heart that can cause damage to the heart valves.  Another reason for her valve findings could be a connective tissue disorder, such as Marfan or Ehlers-Danlos syndromes; these are genetic disorders that are associated with mitral valve prolapse and progression to regurgitation.  The history of the “taller than average” siblings can also be associated with Marfan syndrome.  I definitely do not believe that her mitral valve findings are due to anxiety or emotional problems, nor do I believe that it is associated with vaccinations or the fever that can accompany them.  It would probably be a good idea to ask your primary care provider to assess your daughter for other clinical findings of both Marfan and Ehlers-Danlos syndromes.  As well, ask your cardiologist for more information regarding how the mitral valve appears, which may give some clues to the etiology of her findings.  I do think that it is important to not only take care of the valvular problem at hand with surgery, but have an idea what is going on and why she got there, so as to have a sense of how the valve should hold up with time and if there may be other complications.

[Tlennon]

thank you for your reply.  I have come across Marfan and Ehlers-Danlos syndromes while reading up on mitral valve topics but it hasn't been mentioned by her carers; i will discuss with her doctors at her next appointment.  Hopefully when they get to examine the valve during surgery we may glean some other clues as to what caused it in the first place.  To date she shows no outward symptoms and thankfully can continue with her normal routine however her heart has shown signs of slight enlargement last year when first diagnosed hence the decision to operate; we are currently awaiting a date for the operation but there has been no deterioration in her condition.  Re anxiousness, what I meant was does the mitral valve regurg cause anxiousness/panic attacks rather than it being the cause of the problem in first place.  Thanks again for your comment; a second opinion is always helpful!  

[Jeffrey R Boris, M.D.]

Dear T Lennon,

I'm happy to give my thoughts on your daughter.  I wouldn't necessarily count it as a second opinion, only because I'm not evaluating her completely and am only going on just a bit of information!

A word about the anxiety and panic attacks.  There used to be a lot of thought that mitral valve prolapse caused anxiety, panic attacks, "hysteria", etc.  However, this has not been borne out in the medical literature, so I do not believe that these are associated.  Mitral regurgitation (with or without prolapse) also does not cause these other conditions.  I hope that helps.

[Tlennon]

Yes, it all helps! Thank you for your time and input.