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June 28, 1993

Mitral Valve Prolapse and Infective Endocarditis-Reply

Author Affiliations

Amsterdam, the Netherlands

Leiden, the Netherlands

Arch Intern Med. 1993;153(12):1506. doi:10.1001/archinte.1993.00410120084013

We read Bisno's letter with interest. Its main message seems to be that the findings of he and his coworkers were not due to a diagnostic bias. To support our view that there is, indeed, such a bias, we quoted two articles. In the first article,1 a review of the experience reported in the English-language literature on bacterial endocarditis associated with mitral valve prolapse (MVP), it is stated that "many lesions that would have been classified as rheumatic or indeterminate in the past may now be readily diagnosed by echocardiography as MVP" and "The recognition of MVP as an underlying valvular lesion in IE [infective endocarditis] will continue to increase with the wider availability of echocardiography." In the second article quoted,2 a retrospective review of cases of native valve endocarditis, it is said that the increasing frequency with which MVP is recognized in patients with endocarditis "... has occurred