Diagnosis of mitral valve prolapse is based on modern echocardiographic techniques which can pinpoint abnormal leaflet thickening and other related pathology.
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Mitral valve prolapse

Mitral valve prolapse (MVP) is a heart valve condition marked by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. In its nonclassic form, MVP carries a low risk of complications. In severe cases of classic MVP, complications include mitral regurgitation, infective endocarditis, and — in rare circumstances — cardiac arrest usually resulting in sudden death. more...

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Overview

The mitral valve, so named because of its resemblance to a bishop's miter, is the heart valve that prevents the backflow of blood from the left ventricle into the left atrium. It is composed of two leaflets (one anterior, one posterior) that close when the left ventricle contracts.

Each leaflet is composed of three layers of tissue: the atrialis, fibrosa, and spongiosa. Patients with classic mitral valve prolapse have excess connective tissue that thickens the spongiosa and separates collagen bundles in the fibrosa. This weakens the leaflets and adjacent tissue, resulting in increased leaflet area and elongation of the chordae tendineae. Elongation of the chordae often causes rupture, and is commonly found in the chordae tendineae attached to the posterior leaflet. Advanced lesions — also commonly involving the posterior leaflet — lead to leaflet folding, inversion, and displacement toward the left atrium.

History

For many years, mitral valve prolapse was a poorly understood anomaly associated with a wide variety of both related and seemingly unrelated signs and symptoms, including late systolic murmurs, inexplicable panic attacks, and polythelia (extra nipples). Recent studies suggest that these symptoms were incorrectly linked to MVP because the disorder was simply over-diagnosed at the time. Continuously-evolving criteria for diagnosis of MVP with echocardiography made proper diagnosis difficult, and hence many subjects without MVP were included in studies of the disorder and its prevalence. In fact, some modern studies report that as many as 55% of the population would be diagnosed with MVP if older, less reliable methods of MVP diagnosis — notably M-mode echocardiography — were used today. The term mitral valve prolapse was coined by Dr. Michael Criley in 1966 and gained acceptance over the other descriptor of "billowing" of the mitral valve (as described by Dr. Barlow).

In recent years, new criteria have been proposed as an objective measure for diagnosis of MVP using more reliable two- and three-dimensional echocardiography. The disorder has also been classified into a number of subtypes with respect to these criteria.

Subtypes

Prolapsed mitral valves are classified into several subtypes, based on leaflet thickness, concavity, and type of connection to the mitral annulus. Subtypes can be described as classic, nonclassic, symmetric, asymmetric, flail, or non-flail.

Note: all measurments below, refer to adult patients and applying them to children may be misleading

Classic vs. nonclassic

Prolapse occurs when the mitral valve leaflets are displaced more than 2 mm above the mitral annulus high points. The condition can be further divided into classic and nonclassic subtypes based on the thickness of the mitral valve leaflets: up to 5 mm is considered nonclassic, while anything beyond 5 mm is considered classic MVP.

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What You Should Know About Mitral Valve Prolapse
From American Family Physician, 6/1/00

What is the mitral valve?

The mitral valve controls the flow of blood between two "chambers," or "rooms," of your heart, called the left atrium and the left ventricle. Normally, blood flows only from the atrium to the ventricle. When the heart relaxes in between beats, the two "flaps" of the mitral valve swing open to let blood flow from the atrium to the ventricle. The "hinges" of the flaps keep them from opening the other way. When the heart beats, blood is pushed out of the ventricle and into the blood vessels that carry it to the rest of your body.

What is mitral valve prolapse?

If you have mitral valve prolapse, your flap hinges don't work well. One of the flaps moves back into the atrium when the heart beats. This can let blood flow from the ventricle back into the atrium.

About one in 20 Americans has mitral valve prolapse. People are usually born with it. More women have it than men. How do I know that I have mitral valve prolapse?

Sometimes people with mitral valve prolapse have symptoms, or feelings, that go along with this condition. Here are some of these symptoms:

* Feeling like your heart is racing or is skipping beats

* Chest pain that comes now and then

* Shortness of breath

* Dizziness

* Anxiety or panic

Your doctor can find mitral valve prolapse during a regular exam. When listening to your heart with a stethoscope, your doctor may hear a clicking sound. The flap makes the click. If blood is flowing back into the atrium, your doctor will hear a "whooshing" sound. This sound is called a murmur. To find out how well your valve is working, your doctor will have you get an echocardiogram. The echocardiogram is a special picture of your heart that shows your valve as the blood flows through it. This can help your doctor decide if you need treatment.

How is mitral valve prolapse treated?

Most people with mitral valve prolapse don't need any treatment. In fact, this condition usually has no effect on your health. About two of every 100 people with this condition have complications. You may need surgery to fix the valve if your valve is too leaky or if you are having lots of symptoms. You may also have to limit your participation in competitive sports. Ask your doctor if you are in this group.

If your mitral valve prolapse causes chest pains or other symptoms, your doctor might prescribe medicines such as beta blockers to make your symptoms better.

Some people get an infection in the leaky valve when they have surgery or dental work. You might take antibiotics before surgery or dental work to prevent this infection. Remind your dentists and doctors that you have mitral valve prolapse so that you can get a prescription for antibiotics when you are going to have surgery or dental work.

Where can I learn more about mitral valve prolapse?

You can find out more about mitral valve prolapse at the American Heart Association's Web site: http://www.amhrt.org.

COPYRIGHT 2000 American Academy of Family Physicians
COPYRIGHT 2000 Gale Group

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