Mitral valve prolapse
Mitral valve prolapse was originally described as billowing mitral leaflet and the present name was first used in 1966. It has been subsequently recommended that the term prolapse should be reserved to indicate that the free edge of the leaflet protrudes beyond the mitral annulus level during systole, whereas the term billowing with its different prognosis should be used when the leaflet body bulges into the left atrium, overriding the mitral annulus plane and usually maintaining the free edge of the leaflets on the ventricular side. A mitral valve can be both billowing and prolapsing. The underlying pathology is usually myxomatous degeneration for those coming to surgery. Barlow's syndrome, is a term for the most extreme form of myxomatous degeneration in younger patients with excess leaflet tissue. Older patients tend to have fibroelastic deficiency.
- Most common heart defect in population, commoner in young women.
- Prevalence about 0.6–2.5%
- Increases with age
- Benign without serious consequences except in older men
- Common cause of iatrogenic cardiac neurosis
- Associated with X-linked myxomatous valvular dystrophy, Marfans, Ehlers-Danlos syndrome, osteogenesis imperfecta and at least three other genes
- Mitral valve prolapse symptoms are common despite benign prognosis. They include:
- Some will have those of mitral incompetence
- Auscultation for midsystolic clicks and late-systolic murmurs that may be brought typically by manoeuvers such as squatting.
It is associated with benign arrhythmia. A third will have ventricular arrhythmias, usually ectopics. Ventricular tachycardia is found in less than 2% and predicted by the presence of moderate to severe mitral regurgitation.
- Mitral valve prolapse is when there is displacement of mitral valve leaflet(s) above the annulus into the left atrium during systole
- Cardiovascular magnetic resonance imaging can allow tissue characterization such as the myocardial fibrosis involving the papillary muscle associated with those with more exotic causes of the MVP.
- Multislice computed tomography can help work up in those with severe mitral regurgitation prior to surgery
- Blood culture if endocarditis suspected - there is a small increased risk of this complication due to the secondary mitral and tricuspid regurgitation
- If severe mitral regurgitation or with left ventricular dysfunction (ejection fraction <60%) or with left ventricular dilatation (left ventricular end-systolic dimension >4 cm) surgery should be considered
- ↑ Carpentier A. Cardiac valve surgery--the "French correction". The Journal of thoracic and cardiovascular surgery. 1983 Sep; 86(3):323-37.
- ↑ Devereux RB, Kramer-Fox R, Kligfield P. Mitral valve prolapse: causes, clinical manifestations, and management. Annals of internal medicine. 1989 Aug 15; 111(4):305-17.
- ↑ Grau JB, Pirelli L, Yu PJ, Galloway AC, Ostrer H. The genetics of mitral valve prolapse. Clinical genetics. 2007 Oct; 72(4):288-95.(Link to article – subscription may be required.)
- ↑ Gottlieb SH. Mitral valve prolapse: from syndrome to disease. The American journal of cardiology. 1987 Dec 28; 60(18):53J-58J.
- ↑ a b c Cetinkaya M, Semizel E, Bostan O, Cil E. Risk of vasovagal syncope and cardiac arrhythmias in children with mitral valve prolapse. Acta cardiologica. 2008 Jun; 63(3):395-8.
- ↑ van der Wall EE, Schalij MJ. Mitral valve prolapse: a source of arrhythmias? The international journal of cardiovascular imaging. 2010 Feb; 26(2):147-9.(Link to article – subscription may be required.)
- ↑ Verma S, Mesana TG. Mitral-valve repair for mitral-valve prolapse. The New England journal of medicine. 2009 Dec 3; 361(23):2261-9.(Link to article – subscription may be required.)