Mitral Valve Prolapse In Patients With Benign Joint Hypermobility Syndrome ( BJHS ) *

Al-Kindy College Medical Journal 2017: Vol.13 No. 1 8 www.kmjub.com ABSTRACT Background: Joint hypermobility was first mentioned by Hippocrates as an isolated feature, when he described the Celts' Incapacity to Pull a Bowstring or Throw a Dart, Due to The Slackness of Their Limbs Objective: to determine the prevalence of mitral valve prolapse(MVP)in patients with benign hypermobility syndrome (BJHS). Type of the study: Cross –sectional study. Methods: Ninety patients with BJHS were included in this study. Full cardiological assessment was done for all of them, which include clinical examination, electrocardiography and echocardiography. Cardiac assessment was done for another sixty age and sex matched (normal mobile) Individuals served as a control group. Statistical analysis was done by using T test or chi square as indicated. Results: Among 90 patients with BJHS, MVP was reported in 26 patients (28.9%) compared to four individuals (6.7%)of the control group on modern echocardiography studies (P=0.013). Conclusions: the prevalence of MVP was significantly higher among patients with BJHS compared to normal mobile individuals.

oint hypermobility (JH) was first mentioned by Hippocrates as an isolated feature, when he described the Celts' Incapacity to Pull a Bowstring or Throw a Dart, Due to The Slackness of Their Limbs (1).
Hypermobility Syndrome Is Commonly Occurring and Frequently Overlooked Entity, Which Causes Much Suffering in The Community (2).JH Arouse Great Interest in The Last Decades for Being Associated to Musculoskeletal Dysfunctions, As Well As Abnormalities in Several Organic Systems and Among Them, The Mitral Valve Prolapse (MVP) (3).
Joint Hypermobility (JH) Is Defined As The Capacity To Perform Articular Movement With Higher Range Of Motion The Normal One(4) (5).Its Prevalence Depend On The Characteristics Of The Studied Group Determined ,Among Others ,By Age ,Sex, Ethnicity And Genetic Factors That Have An Effect On The Process Of Movement Evolutions .Studies Have Stated That Female Individuals Have A Higher Joint Mobility Than Male Individuals And That It Decreases With Age (6) (7).Approximately 30% Of The Adult Individuals Are Considered As Presenting JH (8).The Feature of JH That Appear in Some Hereditary Disease Such as Marfan Syndrome, Osteogegesis Imperfecta, Achard Syndrome, Homocystinuria And Hyperlysinemia Must Be Differentiated from Those Present in Normal Population.
JH in the general population is a common condition and a genetically determined one (8).There is a new consensus that the Benign Joint Hypermobility Syndrome (BJHS) is a multisystemic disorder, of which characteristics coincide with the characteristics of the hereditary disorders of the connective tissue, which include Marfan syndrome, Ehlers-Danlos syndrome and Osteogenesis Imperfecta (9).
The MVP is a common cardiovascular disorder, with a strong hereditary component, generally diagnosed in young individuals (10).Mitral valve prolapse was reported during clinical practice in patients with various heritable disorder of connective tissue such as Ehlersdanlose syndrome (12), Marfan's syndrome (13), and Osteogenesis imperfecta (14).
There were conflicting report regarding the association between BJHS and MVP.Some reports show increase incidence (14,15,16,17), and other challenged this association and show no difference between the incidence of MVP in BJHS and normal mobile subjects (18,19).
Methods: Ninety patients with joint hypermobility were included in this cross-sectional study.All patients were evaluated for cardiac and respiratory symptoms and signs.Full cardiological evaluation was done blindly by another physician in all patients, which include clinical examination, electrocardiography and echocardiography, which was performed by using twodimension voluson 5300 D-Kretz technik -S-PPA2-4 with a 2.5MHz probe.
During examination, particular attention was paid to the presence or absence of echocardiographic evidence of MVP according to the echocardiographic diagnostic criteria of MVP by Perloff et al (20), Cardiac assessment was done for another sixty age and sex matched (normal mobile) individuals served as a control group.Statistical analysis, the T-test was used for mean age and chi-square for other variable correlation.
Results: All the 90 hypermobile patients (75 females and15 males), age range from 11 to 40 years with a mean of 22.68+_5.69and 60 normal mobile individuals (50 females and 10 males).The demographic finding of patients with BJHS and controls are shown in table (1).Among the hypermobile group, mitral valve prolapse was diagnosed in 26 patients (4 males and 22 females), two of them with mild mitral regurgitation,5 patients had murmurs on auscultation and another six with mid systolic click.Four individuals of the control group had J www.kmjub.commitral valve prolapse (6.7%) on echocardiography.So, MVP was reported significantly higher among patients with BJHS compared to the control group (P=0.013).There was a report from Venezuela by Riana et al,2001 (24) and although they used the Beighton 9 score criteria and not the new set of criteria for BJHS.There was no mention of the type of echocardiogram used in the study, yet they have concluded that among extra-articular manifestations, MVP was commonest one.Conclusion: The prevalence of MVP was significantly higher among our patients with BJHS compared to normal mobile individuals.