Mitral valve prolapse from childhood to adulthood: morphologic characteristics and mitral regurgitation development. A single-centre echocardiographic study

Background: Mitral valve prolapse (MVP) is a common valvular heart disease with potential for progression to mitral regurgitation (MR) and arrhythmias. While extensively studied in adults, its evolution from childhood remains underexplored. This study aimed to evaluate morphological changes in MVP from paediatric to adult age and their association with MR progression using transthoracic echocardiography (TTE). Methods: This retrospective single-centre study included 53 patients with confirmed MVP diagnosed in childhood and followed up into adulthood (mean follow-up 9 ± 5 years). Each patient had at least two TTEs, and echocardiographic parameters were assessed and indexed for body surface area and height. The presence and progression of mitral annulus disjunction (MAD) were also analysed. Results: At baseline, the mean age was 8.13 ± 3.25 years; at final follow-up, 18.45 ± 6 years. MAD was present in 60% of patients at both TTEs, while 13% developed MAD over time. Indexed MVP morphological parameters, including leaflet length, annular diameter, and MAD distance, remained stable from childhood to adulthood. However, the severity of MR increased over time and was associated with changes in multiple mitral valve parameters, rather than a single feature. No significant arrhythmic events or implantable cardioverter defibrillator (ICD) implantations were recorded. Conclusions: MVP-related structural changes remain morphometrically stable when indexed for growth, yet MR severity can worsen due to a combination of morphological alterations. MAD can be identified in paediatric patients and may develop over time. These findings support the view that MVP may encompass different phenotypes and potentially represent a form of cardiomyopathy.