🫀 Mirza's Cardiology Notes

Mitral Valve Prolapse (MVP)

3 min read

  • Using echocardiography, MVP is diagnosed ideally in the PLAX window as systolic displacement of the mitral leaflet into the LA of ≥2 mm from the mitral annular plane.
    • If parasternal windows are of poor quality, the apical long-axis view can also be used, although the latter is less standardized and thus more variable.
    • ⛔ Diagnosis of MVP should be avoided in the A4C or A2C windows
  • Involves myxomatous degeneration of the mitral valve leaflets → eventually leads to structural incompetence and superior displacement of one or both mitral leaflets into the left atrium (LA) during systole 1
  • Estimated to affect 2% to 3% of individuals1
  • Physical Exam
    • 🩺: mid‐systolic “click” heard best at the apex
      • presence of a late systolic or holosystolic murmur can suggest the presence of MR
  • Diagnosis
    • Echo (gold standard)
  • Patients who experience an increased burden of premature ectopic beats (such as PVCs) are at an increased risk of developing more severe, even life‐threatening arrhythmias.1

Figure source

Barlow disease

  • diffuse, myxoid degeneration of the MV → excess tissue in multiple valve segments, including leaflets and chordae → (typically) both anterior and posterior MVP, as well as annular dilation
  • Compared to fibroelastic deficiency, Barlow disease is less frequently associated with chordal rupture.

Fibroelastic deficiency

  • Caused by abnormalities in connective tissue → leaflet redundancy, chordal thinning and elongation → MVP
    • The thinned and elongated tendinous chords in MVP are prone to rupture
  • Chordal rupture may lead to flail leaflet and a sudden ↑ in MR volume (acute MR)

Malignant MVP

![[Mitral Valve Prolapse MVP-1745637451858.webp]] Figure source Transthoracic echocardiography demonstrating myxomatous bileaflet mitral valve prolapse (arrows) in cases 1 (A), 2 (B), and 3 (C). High-velocity mid-systolic spike (lateral annulus, 32 cm/s) in cases 1 (D), 2 (mid-systole, 19 cm/s) (E), and 3 (late systole, 25 cm/s) (F). (G) Normal medial annulus systolic velocity, case 1. (H) Tugging of the posteromedial papillary muscle by prolapsing leaflets (arrow), case 4. (I) Late-peaking systolic tissue velocity spike of 24 cm/s, case 4. (J) Pickelhaube, spiked German military helmet (reprinted with permission from the collection of Peter Suciu).

Echo

MR quantification in MVP

⛔ Avoid using single frame measurements - PISA EROA and VCW - when the MR is not holosystolic, e.g. MVP with late systolic MR, functional MR with biphasic MR, LV dyssynchrony with early systolic MR, as they can overestimate MR severity.

When non-holosystolic, you should use regurgitant volume (RVol) method.

Doppler

  • Late systolic peak
    • ![[Mitral Valve Prolapse MVP-1745638089042.webp]]

Footnotes

  1. Morningstar, J. E., Nieman, A., Wang, C., Beck, T., Harvey, A., & Norris, R. A. (2021). Mitral Valve Prolapse and Its Motley Crew‐Syndromic Prevalence, Pathophysiology, and Progression of a Common Heart Condition. Journal of the American Heart Association, 10(13). https://doi.org/10.1161/jaha.121.020919 ↩ ↩2 ↩3

Graph View

Backlinks