Mitral Valve Prolapse

Key Features

Essentials of Diagnosis

• Midsystolic click

• Late systolic "whooping" or "honking" murmur

• Typical symptoms include chest pain, palpitations, and dizziness.

• Often overdiagnosed on routine cardiac ultrasound

General Considerations

• Occurs in about 2%of thin female adolescents, a minority of whom have concomitant mitral insufficiency

• Although mitral valve prolapse is usually an isolated lesion, it can occur in association with connective tissue disorders such as

  • Marfan syndrome

  • Loeys-Dietz syndrome

  • Ehlers-Danlos syndrome

Clinical Findings

• Most patients are asymptomatic

• A midsystolic click (with or without a systolic murmur) is the hallmark of this entity.

• Chest pain

• Palpitations

• Dizziness

Diagnosis

Imaging

• Chest radiography

  • Not usually indicated

  • Left atrium may be enlarged in the rare case of significant mitral valve insufficiency

• Echocardiography

  • Assesses the degree of myxomatous change of the mitral valve and the degree of mitral insufficiency

  • Significant posterior systolic movement of the mitral valve leaflets to the atrial side of the mitral annulus is diagnostic

Diagnostic Procedures

• Electrocardiography

  • Usually normal

  • Diffuse flattening or inversion of T waves may occur in the precordial leads

  • U waves are sometimes prominent

• Other testing

  • Invasive procedures are rarely indicated

  • Holter monitoring or event recorders may be useful in establishing the presence of ventricular dysrhythmias in patients with palpitations

Treatment

• Propranolol may be effective in treatment of coexisting arrhythmias

• Prophylaxis for infectious endocarditis is no longer indicated

• Surgery for mitral insufficiency is rarely needed

Outcome

Prognosis

• Twenty years of observation indicate that isolated mitral valve prolapse in childhood is usually a benign entity

Reference