Mitral Valve Prolapse

Mark M. Levinson, MD

Hutchinson Hospital, Hutchinson Kansas

Mitral Valve Prolapse (MVP) is a mild abnormality of a heart valve, usually detected by the presence of a murmur, or a click-like sound heard with a stethoscope. MVP is surprisingly common, with about 2 million Americans diagnosed with this condition.

The mitral valve itself (MV) is a two leaflet, parachute like structure which protects the heart from ejecting blood backwards into the lungs. The MV ensures that blood flows forwards (towards the body) during each heart beat. Mitral valve prolapse occurs as a result of elongation of the suspensory chords to the MV. The process has no known cause, but appears to be a gradual process. It has been classified as "myxomatous degeneration" by some, but this is not a specific diagnosis in reality. The term simply means that the fibrous tissue in the suspensory chords degenerates, leaving a non-fibrous (or "myxomatous") material behind.

In MVP, the valve leaflets billow backwards as the heart contracts. In mild cases, the physician can hear a "click-murmur" which signals the abnormal closure pattern of the valve. Many of the patients first present at a young age with atypical chest pain, usually not related to exertion. Most are women (about 80%). In the absence of congestive heart failure (CHF) symptoms, these patients do not need surgical correction. The only managment consists of:

• annual or bi-annual physical exam
• serial echocardiograms (a sonar-like test) for comparison year-to-year
• antibiotics before and after dental work (to prevent valve infection)

In the more severe forms, the valve will not close properly, and will leak. The murmur is increased, and symptoms of CHF, such as shortness of breath, fatigue, rapid heart rythms (atrial fibrillation), ankle swelling, etc. occur. Once the heart dilates, or symptoms become manifest, then surgical correction is warranted.

Surgery involves either replacing or reconstructing the valve itself. Although it is preferable to repair the valve, multiple elongated chords are hard to fix reliably. Most often the severe forms of MVP should be treated with a new (replacement) valve.

For most patients, the most appropriate treatment is annual or semi-annual follow-up exams and antibiotic prophylaxis before dental care. The latter prevents secondary infection of the valve (aka "endocarditis") from transient bacteria in the blood stirred up by the dental procedure(s). However, in the absence of symptoms or severe valve leakage, nearly all MVP patients are followed without intervention or specific medical therapy. If the valve leakage worsens, then surgery may be indicated. However, the prognosis is excellent, and most patients are followed for many, many years without needing anything specific. Most patients do not need to worry about their physical condition, nor do they need to restrict their physical activities in any way. There is no known risk of sudden death, and this is not a fatal condition. However, there is a small possibility that someday the mitral valve would need to be surgically repaired or replaced.

If you have MVP, rest assured that you don't have anything very serious. Millions of people have mild MVP and need nothing further done. Antibiotics before dental procedures and routine follow-up exams are usually all that is needed. If you have advancing shortness of breath, palpitations, chest pains that occur with exertion, etc. then check back with your cardiologist. Otherwise, enjoy your life to the fullest.

For further information on this subject, you may wish to browse the following web site:

Advanced Nursing Practice WWW page on MVP

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