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Mitral Valve Prolapse
From WikiSM
Other Names
- MVP
- Floppy mitral valve syndrome
- Systolic click-murmur syndrome
- Billowing mitral leaflets
Background
- Defined as displacement of the mitral leaflets superior into the left atrium [1]
History
Epidemiology
- 5% of the general population is thought to be affected
- 6% of young women are thought to be affected [2]
Pathophysiology
- Structural abnormality resulting in the mitral valve leaflets extending beyond the mitral annulus and into the left atrium
- Valvular Theory
- MVP is due to disruption and loss of valve architecture from the spongiosa interrupting and weakening the fibrous mitral support structure [2]
Etiology
- Degenerative (myxomatous) valves
- Occurs mostly in older adults
- Associated with the involvement of both leaflets, excess tissue, enlarged chords, and dilated annulus
- Fibroelastic deficiency
- Seen in elderly past 70 years of age
- More focal effect in nature
- thin and friable leaflets
- Acute rheumatic valve disease
- Sequelae of acute rheumatic fever
- Marfan's Syndrome
- Bacterial endocarditis
- Bacterial damage may lead to ruptured chordae and flail MVP
- Due to vegetation development
- Papillary muscle rupture
- Associated with acute myocardial infarction
- Can lead to severe mitral regurgitation and pulmonary edema
- Acute ischemia
- As is in the setting of acute myocardial infarction [1]
- Genetics
Risk Factors
- Increases with age
- Female sex
- History of:
- Myocardial infarction
- Acute rheumatic fever
- Bacterial endocarditis
- Genetics
Differential Diagnosis
Clinical Features
- General
- History
- Chest Pain
- Usually sharp, left precordial and may last for several hours
- Fatigue
- Palpitations
- Shortness of Breath
- Dizziness
- Syncope, if severe enough
- Most patients are asymptomatic
- Children present with the same symptoms as adults [2]
- Chest Pain
- Physical Exam
- Mid-systolic click on cardiac auscultation is the diagnostic hallmark
- Can also be followed by a mid, or late systolic murmur
- Mid-systolic click on cardiac auscultation is the diagnostic hallmark
- Special Tests
- Valsalva Maneuver
Evaluation
- EKG
- Useful for determining if there are repolarization changes causing arrhythmia
- nonspecific inverted T wave changes and ST-segment depression may also be seen [2]
- Two-dimensional transthoracic (TTE)
- Must be taken in the four-chamber, inter-commissural view, and long-axis plane view
- Measurement of the anterior and posterior leaflet height are necessary measurements to avoid post-surgical complications (ie, Systolic Anterior Motion of the mitral valve)
- 3D Transesophageal Echocardiography (TEE)
- Allows for real-time and reconstructed 3D images of the cardiac valves
- Useful for localizing the prolapsed or flail valve
- Left ventricular angiography was the first diagnostic method but is now outdated [1]
Classification
- Flail Mitral Valve
- Often associated with chordae tendon rupture due to chordal elongation or in the setting of a myocardial infarction
- Billowing Valve with edge-free prolapse
- Used to describe the mild superior billowing motion of the base of the leaflet when it is ≥ 2mm above the mitral plane OR
- When there is billowing of the posterior leaflet
- Associated with excess tissue, myxomatous thickening, chordal elongation, and free-edge prolapse
- Patients may also exhibit a combination of both flail and billowing valve prolapse in various segments of the mitral valve [1]
Management
Prognosis
- Mostly benign
- Progression to mitral regurgitation, chordal rupture, infective endocarditis, and even sudden cardiac death has been seen [2]
Nonoperative
- Medical
- β-blockers may alleviate associated symptoms
- No medications are currently available to correct or directly prevent worsening
Operative
- Mitral Valve Repair
- Various techniques are available for surgical repair including: leaflet resection, plication, artificial chords placement, and leaflet reduction
- Intraoperative TEE is first utilized to determine the degree of repair needed [1]
Rehab and Return to Play
Rehabilitation
Return to Play
- Infrequent or benign premature ventricular complexes and lack of ventricular arrhythmias on Holter monitor
- Athletes may be disqualified from participation when mitral valve prolapse is associated with
- repeated syncopal episodes
- disabling chest pain, especially when made worse by exercise
- complex ventricular arrhythmias
- severe mitral regurgitation
- prolonged QT interval
- History of Marfan's syndrome or sudden cardiac death [2]
Complications
- Transient ischemic attacks
- Infective endocaraditis
- Sudden Death
See Also
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Shah PM. Current concepts in mitral valve prolapse—Diagnosis and management. J Cardiol. 2010 Sep;56(2):125-33.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Jeresaty RM. Mitral valve prolapse: definition and implications in athletes. J Am Coll Cardiol. 1986;7(1):231‐236. doi:10.1016/s0735-1097(86)80286-8
