Abstract
Since the cause of chest discomfort in patients with mitral valve prolapse (MVP) is controversial, we prospectively measured esophageal motility in 14 children, 10 as normal controls and 4 with MVP and chest discomfort. Ages ranged from 10-14 yrs. All had clinical and echocardiographic evidence of MVP and normal left atrial size. None had rhythm disorders. Esophageal manometry was performed with the station pull-through technique and a triple-lumen perfused polyethylene catheter system. 10 wet swallows (3ml water) given at 30 sec. intervals were used to examine the esophageal body. Bernstein acid perfusion tests were performed on all patients.
3 of 4 with MVP and chest discomfort had manometric abnormalities: Diffuse esophageal spasm was present in 1, hypotensive lower esophageal sphincter (<7mm Hg ) in 2. Bernstein tests reproducing chest discomfort were positive in the 2 with hypotensive lower esophageal sphincters. Intensive antacid therapy relieved onest discomfort in 2 patients and dicyclomine was effective in the patient with diffuse esophageal spasm. Control patients had normal esophageal manometric studies with negative Bernstein tests.
Conclusions: 1. In some children with MVP, chest discomfort attributed to MVP may be due to esophageal dysmotility. 2. Children with MVP and chest pain may benefit from esophageal manometry and the Bernstein acid perfusion test prior to the initiation of therapy.
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Woolf, P., Berezin, S., Mellow, M. et al. ESOPHAGEAL DYSMOTILITY: A CAUSE OF CHEST PAIN IN CHILDHOOD MITRAL VALVE PROLAPSE (MVP). Pediatr Res 21 (Suppl 4), 196 (1987). https://doi.org/10.1203/00006450-198704010-00179
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DOI: https://doi.org/10.1203/00006450-198704010-00179