Mitral Valve Prolapse ( MVP)

Other names

Systolic click murmur syndrome

Barlows syndrome
Floppy valve syndrome
Billowing mitral leaflet syndrome
Definition

A variable clinical syndrome of diverse

pathogenic mechanism of mitral valve
apparatus characterized by myxomatous
degeneration with increased concentration
of mucopolysaccharides
Pathology
Myxomatous degeneration of mitral valve
Posterior leaflet is more affected
Mitral annulus is greatly enlarged
Elongated chordae tendinae cause or
contribute MR
MVP usually start with & may progress to
severe MR
Prolapsed valves cause stress to pappilary
muscles
Etiology
Primary etiology not known ( majority)
-? Genetically determined CT
disease
Secondary Marfans syndrome
- RF, RHD
- IHD, mitral valvulotomy
- CMP
- LV anuerysm
- CT disorders
Clinical features
More in females, more in 14-30 years
Most are asymptomatic
Present as
-Arrythmias
-TIAs
-Syncope/ palpitations
-SCD/ chest pain
-IE
Physical signs ( auscultations)
A mid or late systolic click 0.14 sec after S1 due
to sudden tensing of slack elongated chordae
tendinae or maximum excursion by prolapse
mitral leaflet
A high pitched late systolic murmur ( whooping
or honking) at apex
Click or murmur increases by standing/ valsalva
maneuver
Click or murmur decreases by squatting or
isometric exercise
Investigations
ECG : Biphasic T, inverted T in L2,L3,AVF
SVT/ VPC

ECHO : to indentify the abnormal position

& prolapse of mitral valve leaflet
-systolic displacement is >2mm
into the LA

Doppler study : to know MVP with MR

Management of MVP

Reassurance ( asymptomatic patients)

IE prophylaxis when there is MR
Beta blockers for chest pain /SVT
Aspirin for TIAs
Anti coagulants in extreme cases