Mitral Valve Prolapse

Mitral valve prolapse is the most commonly diagnosed heart valve abnormality, affecting five to ten percent of the world population.  A normal mitral valve consists of two thin leaflets, located between the left atrium and the left ventricle of the heart.  In patients with mitral valve prolapse, the mitral valve becomes affected by a process called myxomatous degeneration leading to a stretching of the leaflets and their attachments resulting in a parachute-like appearance.  When the left ventricle contracts, the redundant leaflets prolapse (flop backwards) into the left atrium, sometimes allowing leakage of blood through the valve opening (mitral regurgitation).  When severe, mitral regurgitation can lead to heart failure and abnormal heart rhythms. Most patients are totally unaware of the prolapsing of the mitral valve.  The mitral valve prolapse (MVP) syndrome has a strong hereditary tendency, although the exact cause is unknown. Affected family members are often tall, thin, with long arms and fingers, and straight backs. It is seen most commonly in women from 20 to 40 years old, but also occurs in men.

Mitral valve prolapse and the heart

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What are the signs and symptoms of mitral valve prolapse?

  • Fatigue
  • Palpitations
  • Head-ache
  • Chest pain
  • Anxiety
  • Stroke.

How is mitral valve prolapse diagnosed and evaluated?

Examination of the patient reveals characteristic findings unique to mitral valve prolapse. Using a stethoscope, your doctor may hear a clicking sound soon after the ventricle begins to contract.  If there is associated leakage (regurgitation) of blood through the abnormal valve opening, a “whooshing” sound or heart murmur can be heard immediately following the clicking sound.

Echocardiography is one of the most useful tests for mitral valve prolapse.  Echocardiography can measure the severity of prolapse and the degree of mitral regurgitation.  It can also detect areas of infection on the abnormal valves.  Echocardiography can also evaluate the effect of prolapse and regurgitation on the functioning of the muscles of the ventricles.

What is the treatment for mitral valve prolapse?

The vast majority of patients with mitral valve prolapse have an excellent prognosis and need no treatment.  For these individuals, routine examinations including echocardiograms every few years may suffice.  Mitral regurgitation in patients with mitral valve prolapse can lead to heart failure, heart enlargement, and abnormal rhythms, therefore, mitral valve prolapse patients with mitral regurgitation are often evaluated annually.  Since valve infection, endocarditis, is a rare, but potentially serious complication of mitral valve prolapse, patients with mitral valve prolapse are usually given antibiotics prior to any procedure which can introduce bacteria into the bloodstream.  These procedures include routine dental work, minor surgery, and procedures that can traumatize body tissues such as colonoscopy, gynecologic, or urologic examinations.   Patients with severe prolapse, abnormal heart rhythms, fainting spells, significant palpitations, chest pain, and anxiety attacks may need treatment.

Although most patients with mitral valve prolapse require no treatment or treatment with oral medications, in very rare cases, surgery (mitral valve replacement or repair) may be required. Patients who require surgery usually have severe mitral regurgitation causing worsening heart failure and progressive heart enlargement.   Mitral valve repair is preferable if possible, to mitral valve replacement as the surgical treatment for mitral valve regurgitation.  After mitral valve replacement, lifelong blood thinning medications may be necessary to prevent blood from clotting on the artificial valves.  After mitral valve repair, these blood thinning medications are unnecessary.  Because of the success of valve repair, it is being performed earlier in patients with mitral regurgitation, thus reducing the risk of abnormal heart rhythms and heart failure.

Again, although patients with mitral valve prolapse may experience a variety of complications, most have no symptoms and can lead healthy, active, and normal lives.

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