Antiphospholipid Antibodies in Mitral Valve Prolapse

Tsung O. Cheng. MD, Professor of Medicine, George Washington University, Washington, DC I read with great interest the recent editorial by Nardone Soscia and Romain [ 1 ] on the role of antiphospholipid antibodies in cardiac valvular disease and its throm-boembolic complications. That antiphospholipid antibodies (APLA) can occur in patients without systemic lupus erythematosus or other connective tissue diseases has been reported previously [2-4]. Their role in causing thromboembolic complications in valvular disease of the heart has only recently been implicated [1-4]. Thromboembolism is a dreaded, though rare, complication of mitral valve prolapse (MVP), the commonest valvular disease in the world [5]. The most likely cause of cerebral ischemic attacks in MVP is embolism of a noninfective contact thrombus originating either from the atrial surface of the prolapsing mitral leaflet, or in the angle formed by the junction of the left atrial endocardium and the atrial surface of the prolapsing posterior leaflet (‘angle lesion’) [68]. But it has never been satisfactorily explained why some patients with MVP and normal sinus rhythm develop strokes and most other patients with MVP do not. Perhaps either a retrospective or a prospective study of APLA in patients with MVP with/without an embolic history will shed some light on this enigma. If an association between APLA and stroke could be established in patients with MVP, irrespective of arrhythmias, the need for prophylactic anticoagulant therapy in this subgroup of patients must be considered. On the other hand, a more conservative approach of anti-platelet therapy (aspirin and dipy-ridamole) seems to be the prudent measure in these patients. References Nardone Soscia P, Romain PL: Antiphospholipid antibodies: Is there a role in cardiac valvular disease and its thromboembolic complications; Cardiology 1992;81:1-6. Barbut D, Borer JS, Wallerson D, Ameisen O, Lockshin M: Anticar-diolipin antibody and stroke: Possible relation of valvular heart disease and embolic events. Cardiology 1991;79:99-109. Asherson RA, Khamashta MA, Gil A, Vazquez J-J, Chan O, Baguley E, Hughes GRV: Cerebrovascular disease and antiphospholipid antibodies in systemic lupus erythematosus, lupus-like disease, and the primary antiphospholipid syndrome. AmJMed 1989;86;391-399. Kushner MJ: Prospective study of anticardiolipin antibodies in stroke. Stroke 1990;21:295298. Cheng TO, Barlow JB: Mitral leaflet billowing and prolapse: Its prevalence around the world. Angiology 1989;40:77-87. Cheng TO: Mitral valve prolapse. Dis Month 1987;33:481-534. Cheng TO: Mitral valve prolapse. AnnuRevMed 1989;40:201-211. Cheng TO: Thromboembolism in mitral valve prolapse. J Intern Med 1990:228:291. 20037 (USA) ©1992