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Mitral Valve Prolapse (MVP)
aka “floppy” mitral valve, myxomatous mitral valve, or Barlow’s syndrome Clinical Presentation:
Affected individuals may describe chest pains or palpitations because of associated arrhythmias
Clinical course of MVP is often benign
Most common complication: development of gradually progressive mitral regurgitation
rupture of myxomatous chordae to cause sudden severe regurgitation and pulmonary edema
peripheral emboli due to microthrombus formation behind the billowy valve tissue
atrial or ventricular arrhythmias
late systolic murmur heard best at the cardiac apex
click and murmur are both altered with sudden squatting (click and murmur come later in systole due to increased volume in the LV) and with sudden standing (click and murmur occur earlier in systole due to decreased volume in the LV)
condition may be inherited as a primary autosomal dominant disorder
may occur as a part of other connective tissue diseases such as the Marfan or Ehlers-Danlos syndromes
MVP occurs in about 2.4% of the population and is more common among women, especially those with a lean,
thin body type
Typical path features of MVP are:
Enlarged valve leaflets, especially the posterior leaflet
Instead of dense collage and elastin matrix, the valvular fibrosa is fragmented and replaced with loose, “myxomatous” connective tissue
In severe MVP, may find: elongated or ruptured chordae, annular enlargement, and/or thickened leaflets
The midsystolic click likely corresponds to sudden tensing of the involved mitral leaflet or chordae tendinae as the
leaflet is forced back toward the LA.
Late systolic murmur corresponds to regurgitant flow through the incompetent valve.
oUsed to confirm diagnosis by demonstrating posterior displacement of one or both mitral leaflets into the LA during systole.
Electrocardiogram & Chest X-Ray:
oUsually normal (unless chronic MR has led to LA and LV enlargement).
Reassure the patient about the usually good prognosis for MVP.
Antibiotic prophylaxis for endocarditis, but only if substantial valve thickening or MR are present.