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Mitral Valve Prolapse

Definition


Disease: Mitral Valve Prolapse Mitral Valve Prolapse
Category: Cardiovascular diseases
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Disease Definition:

When the valve between the heart's upper left chamber (left atrium) and the lower left chamber (left ventricle) doesn't close properly, mitral valve prolapse (MVP) occurs. The valve's flaps bulge (prolapse) upward or back into the atrium when the left ventricle contracts. In a condition called mitral valve regurgitation, mitral valve prolapse sometimes leads to blood leaking backward into the left atrium.

Mitral valve prolapse isn't life-threatening and doesn't require treatment or changes in lifestyle in most people. However, some people with mitral valve prolapse do require treatment.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Many people with mitral valve prolapse never have symptoms, although this condition is a lifelong disorder. People may be surprised to learn that they have a heart condition when they're diagnosed.

Because blood is leaking backward through the valve (regurgitation), signs and symptoms occur. From one person to another, mitral valve prolapse symptoms can vary widely; they develop gradually, tend to be mild and they may include:

 

  • Chest pain that's not caused by a heart attack or coronary artery disease
  • Dizziness or lightheadedness
  • A racing or irregular heartbeat (arrhythmia)
  • Fatigue
  • Difficulty breathing or shortness of breath, often when lying flat or during physical activity


One should make an appointment to see a doctor when having any of the above symptoms. Only a visit to the doctor can determine the cause of the symptoms because many other conditions cause the same symptoms as mitral valve prolapse. Emergency medical care should be sought immediately when someone experiences chest pain and isn’t sure if it is a heart attack.
A person should see the doctor if the symptoms worsen in case he/she is already been diagnosed with mitral valve prolapse.

Causes:

The mitral valve closes completely during contraction of the left ventricle and prevents blood from flowing back into the heart's upper left chamber (left atrium) when the heart is working properly. However, the mitral valve's flaps (leaflets) of some people with mitral valve prolapse have extra tissue, bulging (prolapsing) like a parachute into their left atrium each time the heart contracts.

The heart may be prevented from closing tightly due to this bulging. Mitral regurgitation is the case when blood leaks backward through the valve. If only a small amount of blood leaks back into the atrium, this may not cause problems. Symptoms such as fatigue, lightheadedness, a cough or shortness of breath can be caused by more severe mitral valve regurgitation.

Click-murmur syndrome is another name for mitral valve prolapse. The doctor may hear a clicking sound as the valve's leaflets billow out, followed by a murmur resulting from blood flowing back into the atrium when he/she listens to the heart of the patient using a stethoscope. The following are other names to describe mitral valve prolapse:
 

  • Ballooning mitral valve syndrome
  • Barlow's syndrome
  • Floppy valve syndrome

 

Mitral valve prolapse may be linked to other conditions like the following and it often runs in families:

 

 

  • Curvature of the spine, a condition called scoliosis
  • Ehlers-Danlos syndrome
  • Marfan syndrome
  • Ebstein's anomaly
  • Adult polycystic kidney disease

Complications

Complications:

Complications can occur, although most people with mitral valve prolapse never have problems. In middle-aged or older adults, complications are more common and they include the following:

Heart rhythm problems (arrhythmias):
In people with mitral valve prolapse, irregular heart rhythms can occur. They aren't usually life-threatening but they may be bothersome, and they most commonly occur in the upper chambers of the heart. The most susceptible people to serious rhythm problems are those with severe mitral regurgitation or severe deformity of their mitral valve.

Heart valve infection (endocarditis):
Four chambers and four valves lined by a thin membrane called the endocardium are contained in the inside of the heart. The infection of this inner lining is called endocarditis. The chance of getting endocarditis from bacteria that can further damage the mitral valve increases because of an abnormal mitral valve.

Mitral valve regurgitation:
Mitral valve regurgitation (mitral insufficiency) is a condition in which the valve leaks blood back into the left atrium is the most common complication. The risk of mitral valve regurgitation increases when being overweight or having high blood pressure. In order to prevent the development of complications such as heart failure, a surgery may be needed to repair or even replace the valve in case the regurgitation is severe.

Some people with mitral valve prolapse were recommended taking antibiotics before certain dental or medical procedures to prevent endocarditis, but not anymore. For someone with mitral valve regurgitation or mitral valve prolapse, it's advised that antibiotics are no longer necessary in most cases.

Treatments:

Treatment is not required for most people with mitral valve prolapse, especially those without symptoms. Depending on the severity of the condition, surgery or medications may be recommended in case the patient has symptoms.

MEDICATIONS:
To treat mitral valve prolapse-related chest pain, heart rhythm abnormalities or other complications, certain medications may be prescribed if the patient develops symptoms:

Beta blockers:
By making the heart of the patient beat more slowly and with less force, these drugs help prevent irregular heartbeats. To improve blood flow, beta blockers help blood vessels relax and open up.

Acetylsalicylic acid:
To reduce the risk of blood clots, acetylsalicylic acid may be prescribed if the patient has mitral valve prolapse and a personal or family history of strokes.

Prescription anticoagulants (blood thinners):
The blood is prevented from clotting by these medications, and the most commonly used medication is warfarin. However, these medications must be taken exactly as prescribed as they can have dangerous side effects.

SURGERY:
If the patient has severe mitral valve regurgitation with or without symptoms, surgical treatment may be suggested, though most people with mitral valve prolapse don't need surgery. Preventing the heart from effectively pumping blood, severe mitral valve regurgitation can eventually cause heart failure. The heart may be too weak for surgery if regurgitation goes on too long.

There are two main options, repair or replacement of the mitral valve in case the doctor suggests surgery. Open heart surgery is required in both valve repair and replacement, and significant recovery time is needed in both procedures.

Valve Repair:
The surgery that preserves the valve is called mitral valve repair. To correct the condition, this is the preferred surgical treatment for most people with mitral valve prolapse.

The mitral valve consists of two triangular-shaped flaps of tissue called leaflets. Through a ring called the annulus, the leaflets of the mitral valve connect to the heart muscle. To eliminate backward blood flow, the surgeon can modify the original valve (valvuloplasty). By reconnecting valve leaflets or by removing excess valve tissue so that the leaflets can close tightly, the surgeon can repair the valve as well. Replacing or tightening the ring around the valve (annulus) is sometimes included in repairing the valve; this is called an annuloplasty. Ensuring that the surgeon is experienced in performing mitral valve repair is important.

Valve Replacement:
When valve repair isn't possible, valve replacement is done. The damaged mitral valve is replaced by an artificial (prosthetic) valve in valve replacement surgery. The two types of artificial valves are tissue and mechanical.

Mechanical valves may last a long time. However, to prevent the forming of blood clots on the valve, one must use an anticoagulant medication, such as warfarin, if he/she has a mechanical valve. A blood clot could travel to the brain and cause a stroke if it forms on the valve and breaks free.

Tissue valves are made from animal tissue such as a pig's heart valve. Bioprostheses is the name of these kinds of valves. Over time, they may wear out and need replacement. However, not having to use long-term anticoagulant medication is an advantage of the tissue valve.

ANTIBIOTICS RECOMMENDED ONLY IN SOME RARE CASES:
To prevent endocarditis, some people with mitral valve prolapse used to be recommended taking antibiotics before certain dental or medical procedures, but not anymore. In most cases of mitral valve regurgitation or mitral valve prolapse, it's advised that antibiotics are no longer necessary.   

And yet, one should check with the doctor to see how these recommendations apply to him/her in case he/she was told to take antibiotics before any procedures in the past.

PRECAUTIONS DURING PREGNANCY:
The chances of a successful, uncomplicated pregnancy for a pregnant woman who has mitral valve prolapse are good. If there's a risk of an infection that could affect the mitral valve, antibiotics during childbirth are sometimes recommended.

Prognosis:

Not Available

Expert's opinion

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