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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Facts about mitral-valve prolapse - Pamphlet
From Pamphlet by: National Heart, Lung, and Blood Institute, 3/7/00

Table of Contents

Introduction What Is Mitral-Valve Prolapse? Diagnosis Symptoms Treatment Preventing Complications Clinical Significance

The mitral valve is the heart valve between the left atrium and left ventricle. It has two flaps, called leaflets or cusps, which open and close when the heart contracts (beats) and rests.

Mitral-valve prolapse (MVP) is frequently diagnosed in healthy people and is, for the most part, harmless. Most people suffer no symptoms at all. New estimates are that about 2 percent of the adult population has the condition. MVP is also called floppy valve syndrome, Barlow's or Reid-Barlow's syndrome, ballooning mitral valve, midsystolic-click-late systolic murmur syndrome, or click murmur syndrome. MVP can be present from birth or develop at any age and occurs equally in both men and women. MVP is one of the most frequently made cardiac diagnoses in the United States.

What Is Mitral-Valve Prolapse?

The heart's valves work to maintain the flow of blood in one direction, ensuring proper circulation. The mitral valve controls the flow of blood into the left ventricle. Normally, when the left ventricle contracts, the mitral valve closes and blood flows out of the heart through the aortic valve and into the aorta to start its journey to all other parts of the body.

In MVP, the shape or dimensions of the leaflets of the valve are not ideal; they may be too large and fail to close properly or they balloon out, hence the term "prolapse." When the valve leaflets flap, a clicking sound may be heard. Sometimes the prolapsing of the mitral valve allows a slight flow of blood back into the left atrium. This is called "mitral regurgitation," and may cause a sound called a murmur. Some people with MVP have both a click and a murmur and some have only a click. Many have no unusual heart sounds at all; those who do may have clicks and murmurs that come and go.

Diagnosis

Sometimes, once a physician has heard the characteristic sounds of MVP through a stethoscope, other tests may be ordered. Echocardiography is a common and painless test that uses very high frequency sound waves. The sound waves travel through the layers of the skin and muscle to produce an image of the heart that can be seen on a screen. In this sense, it is similar to radar or sonar imaging.

Initially, "M-mode" echocardiography was used. This technology provides a single-plane view of the mitral valve and often resulted in overdiagnosis of MVP in the 1970s and 1980s. A study from National Heart, Lung, and Blood Institute's (NHLBI) Framingham Heart Study, reported in the July 1, 1999 issue of The New England Journal of Medicine, indicated that MVP is less common and less serious than previously thought.

The investigators used standard echocardiography equipment along with new, more accurate criteria that minimize false positive and false negative diagnoses. Whereas earlier estimates put the number of people with MVP at 5 to 35 percent of the population, the new NHLBI study showed the number is closer to 2 percent. In addition, MVP has long been thought to be more prevalent in women than men but the new study reported the condition appears with similar frequency in both men and women.

In light of this new information, NHLBI suggests that people who were diagnosed with MVP since the 1970s might discuss their current health status with their health care provider to determine if a new diagnostic test is warranted.

Symptoms

The vast majority of people with MVP have no discomfort at all. Most are surprised to learn that their heart is functioning in any way abnormally. Some individuals report mild and common symptoms such as shortness of breath, dizziness, and either "skipping" or "racing" of the heart. More rarely, chest pain is reported. However, these are symptoms that may or may not be related to the MVP.

Treatment

In most cases, no treatment is needed. For a small proportion of individuals with MVP, beta-blockers or other drugs are used to control specific symptoms and some blood pressure lowering drugs may be used to treat mitral regurgitation. Serious problems are rare, can easily be diagnosed and, if necessary, treated surgically.

Preventing Complications

The overwhelming majority of people with MVP are free of symptoms and never develop any noteworthy problems. However, it is important to understand that in some cases mitral regurgitation, the flow of blood back into the left atrium, can occur. Where mitral regurgitation has been diagnosed, there is an increased risk of acquiring bacterial endocarditis, an infection in the lining of the heart. To prevent bacterial endocarditis many physicians and dentists prescribe antibiotics before certain surgical or dental procedures. Patients with significant mitral regurgitation should be followed more closely by their physician so that medical therapy and, if necessary, surgery, can be pursued at the appropriate time.

Clinical Significance

As stated, people with MVP have no symptoms and never develop any notable problems. Whether or not there is any discomfort, however, patients should notify their health care providers of the existence of MVP. This will allow decisions and recommendations to be made about the advisability of using antibiotics to protect against bacterial endocarditis.

For More Information Contact The NHLBI InformationCenter

Telephone: (301) 592-8573 Fax: (301) 592-8563

U.S Department Of Health And Human Services

Public Health Service National Institutes of Health

National Heart, Lung, and Blood Institute

NIH Publication No. 00-865 March 2000

Please send us your feedback, comments, and questions by using the appropriate link on the page, Contact the NHLBI.

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COPYRIGHT 2000 National Heart, Lung, and Blood Institute
COPYRIGHT 2004 Gale Group

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