[Mitral valve prolapse in the 8th and 9th decades of life. Anatomo-pathologic study of 3 cases].

Different anatomo-clinic aspects from three mitral valve prolapse cases are compared to those commonly presented in the literature and are also utilized as a basis for a new classification of this disease. The patients are more than 77 years old, what is in contrast with the current concept of MVP as a disease of young-middle aged women. The first case shows marked ostial dilation and many ruptured chordae: as a consequence, this patient showed severe cardiac dysfunction. The anterior, rather than the posterior leaflet, presented intense myxoid degeneration. In the second case, no ruptured chordae were detected and, consequently, the degree of heart failure was lesser than the first one, in spite of the same degree of ostial dilation. Both leaflets showed the same degree of myxoid degeneration. The third patient, who does not have heart failure, showed myxomatous degeneration of both cusps, but no ostial dilation or chordal rupture were present. These aspects reinforce the impression that isolated mixomatous degeneration of the cusps is not so deleterious when compared to those cases where the mitral valvar ring is dilated or its chordae are also involved by that degenerative process. Therefore ostial dimension (normal or enlarged) and the state of the chordae (with or without rupture) appears to be important points to be considered in MVP.