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Mitral valve prolapse (MVP) is a valvular heart disease which is closely associated with generalized disorder or disarray of collagen. So it is frequently observed in patients with Marfan's syndrome, Ehler Danlos, or Benign Joint Hypermobile Syndrome. Nasal septum has two components; osseous and collagenous septums which were mainly composed of type II collagen. Nasal septum deviation may produce anatomically obstruction of nasal passage and also symptoms e.g. dyspnea with varying degree. We aimed to evaluate the frequency of MVP in subjects with NSD and its association with the type of nasal septum deviation.
Echocardiographic examination was performed in patients with NSD and normal nasal passage. Features of mitral valve; thickness of anterior leaflet, presence of prolapsing leaflet (anterior, posterior bileaflet), coexistence of mitral regurgitation (none, trivial, and mild) were recorded and compared according to type of deviation of nasal septum (type I-VI).
Totally, 74 patients with NSD and 38 subjects with normal nasal passage were enrolled to the study. Presence of MVP was significantly higher in patients with NSD compared to normal subjects (%63 vs. %26, p<0.001). Prolapse of anterior, posterior and both leaflets was higher in patients with NSD. Thickness of anterior mitral leaflet was significantly increased in patients with NSD (3.57±0.68 vs 4.59±1.1 mm, p<0.001) compared to normal subjects. Type I, II, and III, IV were higher in frequency in patients with MVP while Type V and VI were higher in normal subjects.
Increased thickness of Mitral anterior leaflet represents the myxomatous degeneration which was closely associated with abnormality of collagen and proteoglycan content. NSD is found to be associated with the presence of MVP and also increased thickness of Mitral anterior leaflet. Co-existence of both those pathologies may be due to abnormality of collagen and proteoglycan content which were highly present in the structure of both mitral valves and nasal septum, especially the cartilaginous septum. Also co-existence of NSD and MVP may contribute and exaggerate the symptoms of patients with MVP probably due to reduced nasal passage and airflow.