title: Reduction in malignant ventricular arrhythmia and appropriate shocks following surgical correction of bileaflet mitral valve prolapse.
abstract: BACKGROUND
  Bileaflet mitral valve prolapse (MVP) can be associated with malignant ventricular arrhythmias. It is unknown whether surgical correction alone of this mitral valve pathology leads to a reduction in ventricular dysrhythmias.
  
  
  METHODS
  We retrospectively analyzed 4477 patients who underwent mitral valve surgery from 1993-2013 at Mayo Clinic in Rochester, MN. Among these, eight patients with bileaflet MVP who had an internal cardioverter defibrillator (ICD) in place both pre- and post-surgery were identified. ICD interrogation records were evaluated for episodes of ventricular tachycardia (VT), ventricular fibrillation (VF), and appropriate ICD shock therapy.
  
  
  RESULTS
  Of these eight patients, five had a malignant ventricular arrhythmia prior to surgery. Data was available 4.6 ± 2.9 years before versus 6.6 ± 4.2 years following surgical intervention. Among these patients, there was a reduction in VF (0.6 versus 0.14 events per-person-year pre- and post-surgery, respectively), VT (0.4 versus 0.05 events per-person-year pre- and post-surgery, respectively), and ICD shocks (0.95 versus 0.19 events per-person-year pre- and post-surgery) following mitral valve surgery.
  
  
  CONCLUSIONS
  We report a series of cases where the surgical correction of bileaflet MVP alone was associated with a reduction in malignant arrhythmia and appropriate shocks. These early observations merit further investigation involving larger cohorts to further evaluate the association between abnormal mechanical forces in degenerative mitral valve disease and ventricular dysrhythmias.
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Vaibhav R
authors.initials: VR
authors.lastname: Vaidya
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Christopher V
authors.initials: CV
authors.lastname: DeSimone
authors.affiliation: University of Minnesota, Minneapolis, MN, USA.
authors.forename: Namrata
authors.initials: N
authors.lastname: Damle
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Niyada
authors.initials: N
authors.lastname: Naksuk
authors.affiliation: Division of Cardiovascular Diseases, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Faisal F
authors.initials: FF
authors.lastname: Syed
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.|Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Rochester, MN, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ackerman
authors.affiliation: Division of Internal Medicine, Mayo Clinic Health System, Austin, MN, USA.
authors.forename: Shiva P
authors.initials: SP
authors.lastname: Ponamgi
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Vuyisile T
authors.initials: VT
authors.lastname: Nkomo
authors.affiliation: Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Noseworthy
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. asirvatham.samuel@mayo.edu.|Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA. asirvatham.samuel@mayo.edu.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Asirvatham
mesh_terms: D015984:Causality; D003131:Combined Modality Therapy / Q000401:mortality / Q000706:statistics & numerical data; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004556:Electric Injuries / Q000401:mortality* / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D058386:Mitral Valve Annuloplasty / Q000401:mortality / Q000706:statistics & numerical data*; D008945:Mitral Valve Prolapse / Q000401:mortality* / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000401:mortality* / Q000517:prevention & control; D016896:Treatment Outcome; D014693:Ventricular Fibrillation
keywords: Bileaflet mitral valve prolapse; Implantable cardioverter defibrillator; Mitral regurgitation; Ventricular fibrillation