The floppy mitral valve syndrome--a review of fourteen patients requiring valve surgery.

The correlation of clinical features with the operative findings in 14 patients with a floppy mitral valve is discussed. The clinical course is typified by rapidly progressive disability. An abrupt deterioration was present in five of our subjects and this may be due to rupture of chordae tendinea or stretching of the valve apparatus. The redundancy of the anterior cusp in 13 of our series may explain the absence of mid systolic clicks in all except one patient. The diagnosis of prolapse can be difficult to make prior to surgery because the prolapsed cusp may be masked by the regurgitant contrast medium. Hypokinesis and prominent inflow sacculation of the left ventricular inflow tract suggest an associated myocardial abnormality. Calcium was present in one valve and thus mitral valve calcification does not exclude the possibility of a floppy valve in patients with mitral regurgitation.