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<b>That's going to be calcification. Now, let's talk about </b>
<b>other mitral valve diseases.</b>
<b>In particular here, mitral valve prolapse, which is also </b>
<b>remarkably common.</b>
<b>In this case, all the other valves are working fine, but you</b>
<b> look at the mitral valve,</b>
<b>and you see that it's regurgitant. It's flopping backwards </b>
<b>into the left atrium,</b>
<b>allowing blood and volume to accumulate in the left atrium.</b>
<b>So, in mitral valve prolapse, the valve leaflets are floppy,</b>
<b>and when we say prolapse, they don't just close, but they do</b>
<b> that.</b>
<b>They prolapse into the left atrium during systole.</b>
<b>It's, as I said, a relatively common entity.</b>
<b>Two to 3% of adults in the USA and worldwide</b>
<b>will have some degree of mitral valve prolapse. Impressive.</b>
<b>And if you are a female, you are at a much higher risk of </b>
<b>having this.</b>
<b>So, it's about a 2 to 1 ratio, women to men.</b>
<b>Most often, it's just an incidental finding in a physical </b>
<b>exam.</b>
<b>There isn't a lot to suggest that you have mitral valve </b>
<b>prolapse.</b>
<b>What the clinician will hear is a mid-systolic click.</b>
<b>Or if it's frankly regurgitant, then you'll hear a murmur of</b>
<b> mitral regurgitation.</b>
<b>But that's usually pretty much all you have in terms of </b>
<b>signs and symptoms.</b>
<b>The ideology is largely unknown, however there are some </b>
<b>associations.</b>
<b>It can be associated with heritable disorders of connective </b>
<b>tissue</b>
<b>and synthetic defects such as Marfan syndrome.</b>
<b>Manifestations of this, you get during mitral valve prolapse</b>
<b>because there is regurgitant flow into the left atrium.</b>
<b>You get a dilated left atrium. That's what's shown there.</b>
<b>The leaflets themselves are enlarged, redundant, billowy.</b>
<b>They look like parachutes. They have various other </b>
<b>descriptions like that.</b>
<b>And they prolapse back up into the left atrium.</b>
<b>To accommodate that, to make that - to make it possible,</b>
<b>if your chordae tendineae are nice and tight, it can't </b>
<b>prolapse.</b>
<b>So, as part in process of the entire disease, of mitral </b>
<b>valve prolapse,</b>
<b>the tendons - the tendonous cords, chordae tendineae,</b>
<b>become elongated and thinned, and sometimes it can even </b>
<b>rupture</b>
<b>because of connective tissue disorders, and they then allow </b>
<b>the valve to prolapse.</b>
<b>Although it is most commonly whenever is the etiology for </b>
<b>this</b>
<b>is most commonly affecting the mitral valve, to some extent,</b>
<b>you can also see insufficiency or redundancy of the aortic </b>
<b>tricuspid and pulmonic valves.</b>
<b>So, as already mentioned, mitral valve prolapse, largely </b>
<b>asymptomatic.</b>
<b>You don't even know that you have it until the clinician </b>
<b>hears a click.</b>
<b>But there is a syndrome that's associated with this,</b>
<b>and patients will often present to emergency rooms</b>
<b>with very atypical chest pain without ECG changes and/or </b>
<b>panic attacks.</b>
<b>And the particular association with both of those is not </b>
<b>particularly understood,</b>
<b>but it's - it is truly an association with mitral valve </b>
<b>prolapse.</b>
<b>So, with this disease, only about 3% of patients will </b>
<b>develop a serious complication,</b>
<b>infective endocarditis being the most important and the most</b>
<b> common.</b>
<b>You can get congestive heart failure.</b>
<b>Clearly, you are in volume overload, particularly in the </b>
<b>left atrium,</b>
<b>and with that happening recurrently,</b>
<b>you may end up pumping more blood retrograde into the lungs</b>
<b>so that you end up with shortness of breath and edema fluid </b>
<b>within the lungs.</b>
<b>Because of the enlarging left atrium and the relative statis</b>
<b>because you are not having good washing motion with pumping </b>
<b>in a single direction,</b>
<b>you can develop thrombi that can then embolize in various </b>
<b>places,</b>
<b>so you can get a stroke or cardiac infarct or more - and </b>
<b>other tissues as systemic infarct.</b>
<b>Arrythmias can occur, particularly with dilation in the left</b>
<b> atrium.</b>
<b>Left atrial dilation is the most common precipitating cause </b>
<b>of atrial fibrillation.</b>
<b>So, arrythmias in this setting with mitral valve prolapse </b>
<b>and regurgitation</b>
<b>are quite common, and sudden cardiac death occurs </b>
<b>portionally</b>
<b>in a very small number but can occur.</b>
<b>This is thought to be due to ischemia of the papillary </b>
<b>muscles as -</b>
<b>because of the abnormal forces exerted by this prolapsing </b>
<b>valve.</b>
<b>Treatment. What do we do for this?</b>
<b>So, for symptomatic patients, particularly those who have </b>
<b>pure honest to goodness</b>
<b>mitral regurgitation, we will do valve replacement surgery.</b>