Mitral Valve Prolapse and Infective Endocarditis

The September 1992 issue of the ARCHIVES contained a two-part study of the epidemiology of bacterial endocarditis in the Netherlands by van der Meer and associates.¹ Although I enjoyed this interesting and thorough review, I must take an exception to one of the authors' conclusions. They found that mitral valve prolapse (MVP) was the underlying risk factor in only 8.3% of their patients with native valve endocarditis. They further state that "these findings contradict the conclusion of some authors that mitral valve prolapse has displaced rheumatic and congenital heart diseases as the major condition underlying endocarditis."¹ They then reference two articles by my colleagues and I^2-3 and state that "the alleged increase in MVP as an underlying cause of endocarditis is probably a diagnostic bias resulting from an increased awareness of this condition." Of the two articles quoted, one² was an extensive review of the English-language