Mitral valve prolapse is the most common cause of chronic mitral regurgitation in developed countries.
One or both leaflets of the mitral valve prolapse into the left atrium during systole.
Diagnosis is established by clinical exam and echocardiography.
Usually follows a benign course with a favorable prognosis.
Uncommonly, serious complications occur such as infective endocarditis, severe mitral regurgitation, or sudden cardiac death. Patients at increased risk are identifiable by clinical and echocardiographic features.
Mitral valve repair is the preferred treatment option in patients with mitral valve prolapse and severe mitral regurgitation.
The degree of associated mitral regurgitation ranges from none to severe.
The mitral valve and annulus are saddle shaped. The echocardiographic definition of MVP is prolapse of leaflet(s) by ≥2 mm above the level of the annulus during systole in the long-axis parasternal view.
In other echocardiographic views, such as the apical 4-chamber view, the leaflets may appear to prolapse even though they remain below the level of the entire mitral valve. This can lead, as happened in older studies, to an incorrect diagnosis of MVP.
History and exam
Key diagnostic factors
- midsystolic click
- late-systolic murmur
Other diagnostic factors
- family history
- slim body type
- connective tissue disorders
- mitral annular disjunction (MAD)
1st investigations to order
Investigations to consider
- Holter or event monitor
- cardiac MRI
- Aortic valve disease
- Pulmonic valve disease
- Atrial myxoma
- 2021 ESC/EACTS guidelines for the management of valvular heart disease
- 2020 Focused update of the 2017 ACC Expert Consensus Decision Pathway on the management of mitral regurgitation
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