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Original research article
Mitral valve and left ventricular features in malignant mitral valve prolapse
  1. Madalina Garbi1,
  2. Patrizio Lancellotti2,3 and
  3. Mary N Sheppard4
  1. 1 King's Health Partners, King’s College Hospital NHS Foundation Trust, London, UK
  2. 2 Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Liège, Belgium
  3. 3 Anthea Hospital, Gruppo Villa Maria Care and Research, Bari, Italy
  4. 4 Cardiovascular Pathology Unit, St Georges Hospital Medical School, London, UK
  1. Correspondence to Dr Madalina Garbi; madalina.garbi{at}


Objective Mitral valve prolapse is a benign condition, however with occasional reports of sudden cardiac death or out-of-hospital cardiac arrest in the absence of severe mitral regurgitation or coronary artery disease, suggesting the existence of a malignant form. The objective of our study was to contribute to the characterisation of malignant mitral valve prolapse.

Methods We performed a retrospective analysis of pathology findings in 68 consecutive cases of sudden cardiac death with mitral valve prolapse as lone abnormal finding, reported as cause of death.

Results All mitral valve prolapse sudden death cases had mitral valve characteristics of Barlow disease, with extensive bileaflet multisegmental prolapse and dilatation of the annulus. The majority of cases (80.9%) had microscopic left ventricular fibrosis with associated hypertrophy and degenerative features of the myocytes, and some cases (10.9%) had right ventricular fibrosis as well.

Conclusions Malignant mitral valve prolapse is Barlow disease. Sudden cardiac death in mitral valve prolapse is due to Barlow disease, which besides the typical mitral valve degeneration may comprise a distinct Barlow disease cardiomyopathy, as suggested by myocyte degeneration and bi-ventricular involvement.

  • mitral valve prolapse
  • malignant mitral valve prolapse
  • Barlow disease

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  • Contributors MG has contributed to planning, conduct, reporting of the work described in the article and is responsible for the overall content as guarantor. PL has contributed to the planning, conduct and reporting of the work described in the article. MNS contributed to planning, conduct, reporting of the work described in the article and is responsible for the overall content as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement No additional unpublished data from the study are available.

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