Mitral Valve Prolapse

by Richard Mitchell, MD

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    00:01 <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>

    About the Lecture

    The lecture Mitral Valve Prolapse by Richard Mitchell, MD is from the course Valvular and Hypertensive Heart Disease.

    Included Quiz Questions

    1. Systole, left atrium
    2. Diastole, left atrium
    3. Systole, left ventricle
    4. Diastole, left ventricle
    5. Systole and diastole, left atrium
    1. It is associated with neurodegenerative disorders.
    2. It is more common in women.
    3. It affects 2%–3% of adults.
    4. It is most often diagnosed incidentally on a physical exam.
    5. Its etiology is largely unknown.
    1. The left atrium becomes dilated.
    2. The left ventricle shrinks in size.
    3. The leaflets atrophy and become calcified.
    4. The chordae tendineae contract and thicken.
    5. The other three cardiac valves do not ever develop prolapse.
    1. Incidental finding
    2. Typical chest pain
    3. Panic attacks
    4. Numbness in arms
    5. Syncope
    1. Aortic regurgitation
    2. Infective endocarditis
    3. Congestive heart failure
    4. Stroke/systemic infarct
    5. Arrhythmias
    1. Mitral valve replacement surgery
    2. Diuretics
    3. Antihypertensives
    4. Heart transplant
    5. Antiarrhythmics

    Author of lecture Mitral Valve Prolapse

     Richard Mitchell, MD

    Richard Mitchell, MD

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