MVP is twice as frequent in women as in men. In the mildest form due to the prolapse of the mitral valve, there is only mid-systolic click but progressively it leads to mitral regurgitation.
MVP exhibits a strong hereditary component and in some patients is transmitted as an autosomal dominant trait.
Etiology:
- Most commonly it develops due to myxomatous degeneration of mitral valve in which the middle layer of valve leaflet composed of loose, myxomatous material is unusually prominent.
- A second common cause in our country is rheumatic fever.
- MVP may occasionally result from Marfan syndrome, Ehlers-Danlos syndrome, osteogenesis imperfecta, periarteritis nodosa, myotonic dystrophy, von Willebrand disease, hyperthyroidism, Ebstein anomaly of the tricuspid valve, hypertrophic cardiomyopathy, ASD II, mitral valve surgery and left ventricular aneurysm.
Clinical Features
Symptoms- Most patients with Mitral Valve Prolapse are asymptomatic.
- In the symptomatic patient, it presents as chest pain, dyspnea, fatigue, palpitation, syncope and sudden death (reasons for symptoms is unknown). Palpitation may be due to atrial or ventricular premature beats or tachyarrhythmias. Chest pain is similar to angina but may last for hours or days, not related to exertion, and punctuated by brief attacks or severe stabbing pain at the apex. This chest pain or discomfort may be due to abnormal tension and papillary muscles.
- Mitral regurgitation (MR) may develop due to the progressive elongation of chordae teninae.
- Spontaneous rupture of chordae tendinae may cause a sudden worsening of MR that is hemodynamically severe.
- On auscultation, there is mid systolic click in mild cases and pansystolic murmur if significant mitral regurgitation. Thoracic deformities are more prevalent in Mitral Valve Prolapse such as loss of normal thoracic kyphosis (straight back syndrome) pectus excavatum and scoliosis.
- BP may be normal or low.
Complications
- Infective endocarditis
- Rupture of chordae tendineae causing sudden severe MR.
- Progressive MR
- Arrhythmias and sudden death.
Investigations
ECG may be normal or show arrhythmias such as SVT, atrial or ventricular premature contractions, ventricular tachyarrhythmias, sinus node dysfunction or varying degrees of heart block.Echocardiography is a diagnostic of Mitral Valve Prolapse (MVP). It shows one or both mitral valve leaflets bulging by at least 2mm into the left atrium during systole. The thickening of the involved leaflet to > 5 mm supports the diagnosis. Doppler echo frequently reveals mild MR that is not always associated with an audible murmur.
Management
- Asymptomatic patients without arrhythmia on ECG should be reassured about the prognosis and follow up every 3-5 years.
- Beta-blockers and aspirin
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