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Mitral Valve Prolapse

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Other Names

  • MVP
  • Floppy mitral valve syndrome
  • Systolic click-murmur syndrome
  • Billowing mitral leaflets


  • Defined as displacement of the mitral leaflets superior into the left atrium [1]



  • 5% of the general population is thought to be affected
  • 6% of young women are thought to be affected [2]


  • 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]


  • 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]
  • Physical Exam
    • Mid-systolic click on cardiac auscultation is the diagnostic hallmark
      • Can also be followed by a mid, or late systolic murmur
  • Special Tests
    • Valsalva Maneuver


  • 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]


  • 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]



  • Mostly benign
  • Progression to mitral regurgitation, chordal rupture, infective endocarditis, and even sudden cardiac death has been seen [2]


  • Medical
    • β-blockers may alleviate associated symptoms
    • No medications are currently available to correct or directly prevent worsening


  • 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


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]


  • Transient ischemic attacks
  • Infective endocaraditis
  • Sudden Death

See Also


  1. 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. 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
Created by:
John Kiel on 13 June 2019 09:09:46
Last edited:
28 May 2020 19:33:02