Mitral Valve Prolapse

Mitral valve prolapse (MVP) is defined as the presence of excessive or redundant mitral leaflet tissue due to myxomatous degeneration of mitral valve leaflets and/or chordae tendineae. The redundant leaflet(s) prolapse toward the LA in systole, which results in the auscultated click and murmur. Some patients with mitral prolapse have findings of a systemic collagen abnormality like Marfan or Ehlers-Danlos syndrome.

In these conditions, a dilated aortic root and aortic regurgitation may coexist. In many persons, the “degenerative” myxomatous mitral valve leads to long-term sequelae and is the most common cause of mitral regurgitation in developed countries. It is common in females between 15 and 30 years; however, severe mitral regurgitation caused by prolapse is more frequent in older males than young females.

Clinical Features

  • Symptoms
    • Asymptomatic
    • Atypical chest pain (precordial, stabbing)
    • Palpitation (due to ventricular ectopics, supraventricular tachycardia, ventricular tachycardia)
    • Syncope or presyncope (lightheadedness, dizziness)
    • Orthostatic phenomena (orthostatic tachycardia, hypotension, and arrhythmias)
    • Fatigue
    • Rarely, symptoms of left ventricular failure like exertional dyspnoea, orthopnoea and paroxysmal nocturnal dyspnoea in patients with severe mitral regurgitation
    • Rarely, sudden death
    • Rarely, transient ischaemic attacks
  • Signs
    • Some patients have mid systolic or late systolic click without the murmur; others may have the systolic murmur without the click.
    • Standing and the Valsalva maneuver increase murmur and click intensity because these maneuvers reduce LV chamber size, allowing the click and murmur to occur earlier in systole.
    • Squatting decreases murmur and click because it increases LV chamber size, thus delaying the onset of the click and murmur.

Investigation in Mitral valve prolapse

  • Most patients are asymptomatic, so diagnosis is typically made on the basis of the murmur and echocardiography alone.
  • Patients with symptoms of arrhythmia require ambulatory ECG monitoring.

Treatment for Mitral valve prolapse

  • If the patient is asymptomatic, reassurance.
  • For chest pain, palpitation, anxiety or fatigue, β-blockers have been useful,
  • Surgery is rarely required. The condition is generally benign.
  • Surgery is required for significant MR, a flail leaflet caused by a ruptured chorda, or marked chordal elongation.

References

  1. https://pubmed.ncbi.nlm.nih.gov/15705461

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