Mitral valve prolapse - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Mitral valve prolapse is the most common cause of chronic mitral regurgitation in developed countries.
One or both leaflets prolapse into the left atrium during systole.
Diagnosis is established by clinical exam and echocardiography.
Usually follows a benign course with a favorable prognosis.
Uncommonly, serious complications occur such as infective endocarditis, severe mitral regurgitation, or sudden cardiac death. Patients at increased risk are identifiable by clinical and echocardiographic features.

Quick Reference

History & Exam
- Key Factors
- Other Factors
More information...
Diagnostics Tests
More information...
Treatment Options
More information...

Definition

Epidemiology

Etiology

Pathophysiology

Images

Parasternal long-axis echocardiogram of mitral valve illustrating prolapse of posterior leaflet (red arrow)
Mitral valve en-face view with single P2 segment prolapse

Citations

Key Articles

Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021 Feb 2;143(5):e72-e227.[Abstract][Full Text]
Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC guidelines for the management of endocarditis. Eur Heart J. 2023 Oct 14;44(39):3948-4042.[Full Text]
Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2021 Aug 28:ehab395.[Abstract][Full Text]

Referenced Articles

1. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021 Feb 2;143(5):e72-e227.[Abstract][Full Text]
2. Bonow RO, O'Gara PT, Adams DH, et al. 2020 Focused update of the 2017 ACC expert consensus decision pathway on the management of mitral regurgitation: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2020 May 5;75(17):2236-70.[Abstract][Full Text]
3. Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017 Apr;30(4):303-71.[Abstract][Full Text]
4. Freed LA, Benjamin EJ, Levy D, et al. Mitral valve prolapse in the general population: the benign nature of echocardiographic features in the Framingham heart study. J Am Coll Cardiol. 2002 Oct 2;40(7):1298-304.[Abstract][Full Text]
5. Marks AR, Choong CY, Sanfilippo AJ, et al. Identification of high-risk and low-risk subgroups of patients with mitral-valve prolapse. N Engl J Med. 1989 Apr 20;320(16):1031-6.[Abstract]
6. Nishimura RA, McGoon MD, Shub C, et al. Echocardiographically documented mitral valve prolapse: long-term follow-up of 237 patients. N Engl J Med. 1985 Nov 21;313(21):1305-9.[Abstract]
7. Levine RA, Triulzi MO, Harrigan P, et al. The relationship of mitral annular shape to the diagnosis of mitral valve prolapse. Circulation. 1987 Apr;75(4):756-67.[Abstract]
8. Levine RA, Stathogiannis E, Newell JB, et al. Reconsideration of echocardiographic standards for mitral valve prolapse: lack of association between leaflet displacement isolated to the apical four chamber view and independent echocardiographic evidence of abnormality. J Am Coll Cardiol. 1988 May;11(5):1010-9.[Abstract][Full Text]
9. Warth DC, King ME, Cohen JM, et al. Prevalence of mitral valve prolapse in normal children. J Am Coll Cardiol. 1985 May;5(5):1173-7.[Abstract][Full Text]
10. Savage DD, Garrison RJ, Devereux RB, et al. Mitral valve prolapse in the general population. 1. Epidemiologic features: the Framingham study. Am Heart J. 1983 Sep;106(3):571-6.[Abstract]
11. Adams DH, Rosenhek R, Falk V. Degenerative mitral valve regurgitation: best practice revolution. Eur Heart J. 2010 Aug;31(16):1958-66.[Abstract][Full Text]
12. Shell WE, Walton JA, Clifford ME, et al. The familial occurrence of the syndrome of mid-late systolic click and late systolic murmur. Circulation. 1969 Mar;39(3):327-37.[Abstract]
13. Savage DD, Devereux RB, Garrison RJ, et al. Mitral valve prolapse in the general population; 2. Clinical features: the Framingham study. Am Heart J. 1983 Sep;106(3):577-81.[Abstract]
14. Freed LA, Acierno JS Jr., Dai D, et al. A locus for autosomal dominant mitral valve prolapse on chromosome 11p15.4. Am J Hum Genet. 2003 Jun;72(6):1551-9.[Abstract][Full Text]
15. Devereux RB, Hawkins I, Kramer-Fox R, et al. Complications of mitral valve prolapse: disproportionate occurrence in men and older patients. Am J Med. 1986 Nov;81(5):751-8.[Abstract]
16. Disse S, Abergel E, Berrebi A, et al. Mapping of a first locus for autosomal dominant myxomatous mitral-valve prolapse to chromosome 16p11.2-p12.1. Am J Hum Genet. 1999 Nov;65(5):1242-51.[Abstract][Full Text]
17. Nesta F, Leyne M, Yosefy C, et al. New locus for autosomal dominant mitral valve prolapse on chromosome 13: clinical insights from genetic studies. Circulation. 2005 Sep 27;112(13):2022-30.[Abstract][Full Text]
18. Davies MJ, Moore BP, Braimbridge MV. The floppy mitral valve: study of incidence, pathology, and complications in surgical, necropsy, and forensic material. Br Heart J. 1978 May;40(5):468-81.[Abstract][Full Text]
19. King BD, Clark MA, Baba N, et al. "Myxomatous" mitral valves: collagen dissolution as the primary defect. Circulation. 1982 Aug;66(2):288-96.[Abstract]
20. Hirata K, Triposkiadis F, Sparks E, et al. The Marfan syndrome: cardiovascular physical findings and diagnostic correlates. Am Heart J. 1992 Mar;123(3):743-52.[Abstract]
21. Leier CV, Call TD, Fulkerson PK, et al. The spectrum of cardiac defects in the Ehlers Danlos syndrome, types I and III. Ann Intern Med. 1980 Feb;92(2 Pt 1):171-8.[Abstract]
22. Lebwohl MG, Distefano D, Prioleau PG, et al. Pseudoxanthoma elasticum and mitral valve prolapse. N Engl J Med. 1982 Jul 22;307(4):228-31.[Abstract]
23. Griffin BP. Timing of surgical intervention in chronic mitral regurgitation: is vigilance enough? Circulation. 2006 May 9;113(18):2169-72.[Abstract][Full Text]
24. Lax D, Eicher M, Goldberg SJ. Mild dehydration induces echocardiographic signs of mitral valve prolapse in healthy females with prior normal cardiac findings. Am Heart J. 1992 Dec;124(6):1533-40.[Abstract]
25. Schreiber TL, Feigenbaum H, Weyman AE. Effect of atrial septal defect repair on left ventricular geometry and degree of mitral valve prolapse. Circulation. 1980 May;61(5):888-96.[Abstract]
26. Van der Bijl P, Stassen J, Haugaa KH, et al. Mitral annular disjunction in the context of mitral valve prolapse: identifying the at-risk patient. JACC Cardiovasc Imaging. 2024 Apr 18:S1936-878X(24)00119-0.[Abstract][Full Text]
27. Basso C, Iliceto S, Thiene G, et al. Mitral valve prolapse, ventricular arrhythmias, and sudden death. Circulation. 2019 Sep 10;140(11):952-64.[Abstract][Full Text]
28. Aabel EW, Chivulescu M, Lie ØH, et al. Ventricular arrhythmias in arrhythmic mitral valve syndrome-a prospective continuous long-term cardiac monitoring study. Europace. 2023 Feb 16;25(2):506-16.[Abstract][Full Text]
29. Garg P, Swift AJ, Zhong L, et al. Assessment of mitral valve regurgitation by cardiovascular magnetic resonance imaging. Nat Rev Cardiol. 2020 May;17(5):298-312.[Abstract][Full Text]
30. Essayagh B, Iacuzio L, Civaia F, et al. Usefulness of 3-tesla cardiac magnetic resonance to detect mitral annular disjunction in patients with mitral valve prolapse. Am J Cardiol. 2019 Dec 1;124(11):1725-30.[Abstract]
31. Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC guidelines for the management of endocarditis. Eur Heart J. 2023 Oct 14;44(39):3948-4042.[Full Text]
32. Attenhofer Jost CH, Turina J, Mayer K, et al. Echocardiography in the evaluation of systolic murmurs of unknown cause. Am J Med. 2000 Jun 1;108(8):614-20.[Abstract]
33. Fornes P, Heudes D, Fuzellier JF, et al. Correlation between clinical and histologic patterns of degenerative mitral valve insufficiency: a histomorphometric study of 130 excised segments. Cardiovasc Pathol. 1999 Mar-Apr;8(2):81-92.[Abstract]
34. Avierinos JF, Gersh BJ, Melton LJ 3rd, et al. Natural history of asymptomatic mitral valve prolapse in the community. Circulation. 2002 Sep 10;106(11):1355-61.[Abstract][Full Text]
35. Takamoto T, Nitta M, Tsujibayashi T, et al. The prevalence and clinical features of pathologically abnormal mitral valve leaflets (myxomatous mitral valve) in the mitral valve prolapse syndrome: an echocardiographic and pathological comparative study [in Japanese]. J Cardiol Suppl. 1991;25:75-86.[Abstract]
36. Zuppiroli A, Mori F, Favilli S, et al. Arrhythmias in mitral valve prolapse: relation to anterior mitral leaflet thickening, clinical variables, and color Doppler echocardiographic parameters. Am Heart J. 1994 Nov;128(5):919-27.[Abstract]
37. Cheitlin MD, Armstrong WF, Aurigemma GP, et al. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article - a report of the American College of Cardiology/American Heart Association task force on practice guidelines (ACC/AHA/ASE committee to update the 1997 guidelines for the clinical application of echocardiography). Circulation. 2003 Sep 2;108(9):1146-62.[Abstract][Full Text]
38. Olson LJ, Subramanian R, Ackermann DM, et al. Surgical pathology of the mitral valve: a study of 712 cases spanning 21 years. Mayo Clin Proc. 1987 Jan;62(1):22-34.[Abstract]
39. Wilcken DE, Hickey AJ. Lifetime risk for patients with mitral valve prolapse of developing severe valve regurgitation requiring surgery. Circulation. 1988 Jul;78(1):10-4.[Abstract]
40. Hayek, E, Gring GN, Griffin BP. Mitral valve prolapse. Lancet. 2005 Feb 5-11;365(9458):507-18.[Abstract]
41. Winkle RA, Lopes MG, Goodman DJ, et al. Propranolol for patients with mitral valve prolapse. Am Heart J. 1977 Apr;93(4):422-7.[Abstract]
42. Orencia AJ, Petty GW, Khandheria BK, et al. Risk of stroke with mitral valve prolapse in population-based cohort study. Stroke. 1995 Jan;26(1):7-13.[Abstract][Full Text]
43. Avierinos JF, Brown RD, Foley DA, et al. Cerebral ischemic events after diagnosis of mitral valve prolapse: a community-based study of incidence and predictive factors. Stroke. 2003 Jun;34(6):1339-44.[Abstract][Full Text]
44. Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke. 2021 Jul;52(7):e364-e467.[Abstract][Full Text]
45. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2021 Aug 28:ehab395.[Abstract][Full Text]
46. Lansberg MG, O'Donnell MJ, Khatri P, et al. Antithrombotic and thrombolytic therapy for ischemic stroke: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(2 Suppl):e601S-36S.[Abstract][Full Text]
47. Writing Committee Members., Otto CM, Nishimura RA, et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021 Feb 2;77(4):450-500.[Abstract][Full Text]
48. Maron BJ, Zipes DP. Introduction: eligibility recommendations for competitive athletes with cardiovascular abnormalities - general considerations. J Am Coll Cardiol. 2005 Apr 19;45(8):1318-21.[Abstract]
49. Maron BJ, Ackerman MJ, Nishimura RA, et al. Task Force 4: HCM and other cardiomyopathies, mitral valve prolapse, myocarditis, and Marfan syndrome. J Am Coll Cardiol. 2005 Apr 19;45(8):1340-5.[Abstract][Full Text]
50. Scottish Intercollegiate Guidelines Network. Antithrombotics: indications and management: a national clinical guideline. Jun 2013 [internet publication].[Full Text]
51. Barber JE, Kasper FK, Ratliff NB, et al. Mechanical properties of myxomatous mitral valves. J Thorac Cardiovasc Surg. 2001 Nov;122(5):955-62.[Abstract]
52. Frary CJ, Devereux RB, Kramer-Fox R, et al. Clinical and health care cost consequences of infective endocarditis in mitral valve prolapse. Am J Cardiol. 1994 Feb 1;73(4):263-7.[Abstract]
53. Kligfield P, Levy D, Devereux RB, et al. Arrhythmias and sudden death in mitral valve prolapse. Am Heart J. 1987 May;113(5):1298-307.[Abstract]