RESUMO
Many years of observations over 80 children with meso-telesystolic clicks have brought evidence that these clicks usually come in combination with late systolic murmur and specific alterations in the posterio-phrenic portion of the left ventricle myocardium. The prevalent view today is that at the root of this interrelated triad lies a single intracardiac pathogenetic mechanism triggered by various causative factors. The pathology in question is met with in children of different age and may appear as a consequence of congenital maldevelopment, of an overt or cubclinical inflammation and also of a fibrotic process in the subvalvular region of the posterio-phrenic portion of the left ventricle. Clinical observations point also to the etiological part played by the rheumatic heart disease in the development of the said changes. It is on rare occasions only that the systolic click is of an extracardiac origin, being caused by pleuropericardiac adhesions. The meso-telesystolic click and late systolic murmur, being an expression of a mild and moderate mitral insufficiency, have a favourable prognosis.
