Key result
Mitral valve repair suppresses recurrent VF and ICD shocks in 1 patient with malignant MVP.
Why the study?
Key questions remain whether malignant arrhythmogenic MVP can occur without severe MR or detectable myocardial fibrosis, which risk markers identify imminent sudden cardiac death risk, and if early surgical correction suppresses ventricular arrhythmias.
Does mitral valve repair prevent ventricular arrhythmias in patients with malignant mitral valve prolapse?
Case Report (n=1)
Does mitral valve repair prevent ventricular arrhythmias in patients with malignant mitral valve prolapse?
Mitral valve repair can suppress life-threatening ventricular arrhythmias in patients with malignant mitral valve prolapse, even in the absence of severe mitral regurgitation.
Malignant arrhythmogenic MVP may occur despite mild MR; this case leaves open the need for better arrhythmic risk stratification.
CLINICAL CONDITION: A 45-year-old woman with long-standing bileaflet myxomatous mitral valve prolapse (MVP), mitral annular disjunction, and mild mitral regurgitation (MR) developed near-syncope and was found to have frequent polymorphic ventricular tachycardia on ambulatory monitoring. Despite medical therapy, she experienced recurrent ventricular fibrillation and multiple implantable cardioverter-defibrillator (ICD) shocks. KEY QUESTIONS: Can malignant arrhythmogenic MVP occur in the absence of severe MR or detectable myocardial fibrosis on cardiac magnetic resonance imaging? Which combination of electrical and mechanical risk markers identifies patients at imminent risk for sudden cardiac death? Can early surgical correction of the mechanical substrate durably suppress ventricular arrhythmias? OUTCOME: The patient underwent mitral valve repair. Since then, she has remained free of arrhythmias and ICD shocks. TAKE-HOME MESSAGES: Malignant MVP can manifest with multifocal ventricular tachycardia independent of MR severity. Prophylactic ICD placement followed by definitive mitral valve repair reduces arrhythmic triggers and prevents sudden cardiac death.
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Javadi et al. (2026) conducted a case report in Malignant mitral valve prolapse with ventricular arrhythmias (n=1). Mitral valve repair and prophylactic ICD placement was evaluated on Freedom from arrhythmias and ICD shocks. Mitral valve repair successfully suppressed recurrent ventricular fibrillation and ICD shocks in 1 patient with malignant mitral valve prolapse and mild mitral regurgitation.
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