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Jan 21, 2012

Mitral valve prolapse (MVP), Systolic click murmur syndrome, Barlow syndrome, Bilowing mitral cusp syndrome, Myxomatous mitral valve syndrome, floppy valve syndrome and Redundant cusp syndrome


.Mitral valve anatomy

Mitral valve consist of leaflets , chordae, papillary muscles, and annulus
Leaflets :- These are shutters of valve
Chordae: - These are attachments between leaflets and papillary muscle and they restrict movement of leaflets in to atrium during systole
Papillary muscles are attached to ventricle.

Why valve prolapse  in mitral valve prolapse?
Mitral valve prolapse is a disease of valve between left atrium and left ventricle. In this disease, valve leaflets which shut the valve during systole, tend to prolapse in to left atrium so the effective closer of mitral valve is not present so can cause Mitral regurgitation (leaky valve)
Mitral valve prolapse is common in young female, it can also occur even in  old male patients
Mitral leaflets are large in MVP. Inter distance of Chordae is more. Leaflets tend to hood into left atrium during systole. so closer of leaflets does not occur in systole. which leads to leaky valve i.e. mitral regurgitation.
Although vast patients of Mitral valve prolapse do not have any symptoms throughout life, as this disease is more common, so it is a common reason for mitral valve surgery and infective endocarditis in united states.

Symptoms of Mitral valve
·         May not have any symptoms (diagnosed by echocardiography or auscultation of heart for some other reason)
·         Palpitation
·         Fatigability
·         Anxiety
·         Syncope or presyncope
·         orthostatic hypotension
·         Chest pain
These patients are usually thin; blood pressure may normal or low
On auscultation with stethoscope, your doctor may hear click (non-ejection click) and murmur (late systolic murmur)
Investigation
Echocardiography is used to diagnose mitral valve prolapse.
ECG may shows T wave inversion in inferior leads may confuse with heart attack
CT scan and MRI can be used for confirmation, in cases suboptimal echocardiography
Arrhythmias with mitral valve prolapse
Premature atrial and also ventricular contraction are common
Association with Wolff-Parkinson-White syndrome, leads supraventricular tachycardia in some patients
Long QT syndrome association in some patients, can lead to ventricular tachycardia
Disease course
Most patients of mitral prolapse remain asymptomatic throughout life without any problems
Mitral valve prolapse is common in young female they have more benign coarse.
Mitral valve prolapse of old male is more prone for complication like Mitral regurgitation needing surgery.
Severe Mitral regurgitation and Infective endocarditis are common in patients who have by auscultation, murmur and clicks, less common in patients with only click
Patients of severe mitral regurgitation are prone to develop heart failure  and atrial fibrillation
Some patients can develop hemiplegia (stroke)
Sudden death secondary to ventricular arrhythmia
Management and follow-up of patients
Patients with mitral regurgitation need to undergo echocardiography test, once in year to know progression of disease and patients without mitral regurgitation echocardiography, once in three to four years is needed.
If patients have palpitation, syncope or presyncope, giddiness with or without ECG/EKG showing QT prolongation, 24hour Holter monitoring and ECG stress test, is needed, to rule out arrhythmia. If arrhythmias detected, then beta-blockers are advised
Radiofrequency ablation is done for associated Wolff-Parkinson-White syndrome
For documented brain stroke Aspirin is advised
Mitral valve prolapse patient with severe mitral regurgitation are treated surgically, with mitral valve repair or mitral valve replacement.