Mitral Valve Prolapse Follow-up

  • Author: Bhavik V Thakkar, MD; Chief Editor: Richard A Lange, MD   more...
 
Updated: Jul 12, 2011
 

Further Outpatient Care

  • Depending on its severity, patients with MVP may be monitored regularly with a careful history, physical examination, and echocardiography when indicated.
  • If symptoms or physical findings change during outpatient care, echocardiography or other studies (ie, Holter monitor, radiography) may be indicated.
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Complications

  • Severe mitral regurgitation
    • This is the most common complication of MVP and leading cause of isolated mitral regurgitation requiring mitral valve surgery in the United States.
    • Severe mitral regurgitation is most frequently due to rupture of the chordae tendineae.
    • The risk increases with the following factors: patients older than 50 years, male sex, history of hypertension, increased BMI, increased mitral valve thickness or redundancy, and left atrial and left ventricular dilatation.
  • Infective endocarditis
    • The main mechanism for increased risk is a turbulent flow state due to leaflet thickness or redundancy and mitral regurgitation.
    • The risk of endocarditis increases 3- to 8-fold with MVP.
    • The main predictors are age older than 50 years, male sex, history of hypertension, increased BMI, left atrial and ventricular enlargement, and increased mitral valve thickness or redundancy.
    • If an isolated mid-to-late systolic click is present (eg, no murmur), antibiotic prophylaxis is not usually recommended unless the echocardiogram demonstrates significant leaflet redundancy and/or thickness.
  • Sudden cardiac death and cerebrovascular ischemic events
    • The association between sudden cardiac death and MVP is not well understood. Data suggest that MVP alone does result in excessive atrial or ventricular arrhythmias, which are most likely due to autonomic dysfunction. Patients with these findings have been said to have MVP syndrome.
    • The risk is increased when patients have evidence of left ventricular dilatation and dysfunction, severe mitral regurgitation, and increased mitral leaflet thickness or redundancy.
    • In the presence of QT prolongation and frequent ventricular ectopy, especially nonsustained ventricular or sustained ventricular tachycardia, an electrophysiologic study may be indicated to quantitate the risk of inducible ventricular tachycardia and/or ventricular fibrillation and sudden arrhythmic death.
    • In regard to cerebrovascular ischemic events, recent studies yielded mixed findings in terms of the association between the increased prevalence of cerebrovascular events and MVP in young patients without evidence of cerebrovascular disease.
      • Gilon et al describes the lack of an association between MVP and stroke in young patients in a large case-control study.[5]
      • The hypothesized mechanism is the formation of platelet fibrin thrombi on the denuded, damaged myxomatous valves resulting in embolization. Data suggest that the prevalence of this mechanism is based on the degree of mitral regurgitation.
    • The major risk factors for cerebrovascular events include age older than 50 years, thickened mitral valve leaflets, atrial fibrillation, and a need for mitral valve surgery.
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Prognosis

  • Most patients with MVP are asymptomatic and have a benign course.
  • Patients with high-risk characteristics and/or progressive mitral regurgitation are at increased risk for complications.
  • See also the Mortality/Morbidity and Complications sections.
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Patient Education

  • Patients should receive education regarding their prognosis along with the signs and symptoms of disease progression.
  • Of emphasis, most patients with MVP have a benign course, but the risk of ruptured chordae and/or clinically significant mitral regurgitation, infective endocarditis, embolic TIA or stroke, and rare sudden death must also be discussed.
  • For excellent patient education resources, visit eMedicine's Heart Center. Also, see eMedicine's patient education article Mitral Valve Prolapse.
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Contributor Information and Disclosures
Author

Bhavik V Thakkar, MD  Associate Faculty, Department of Medical Education, Abbott Northwestern Hospital; Consulting Staff, Department of Medicine, Regency Hospital

Bhavik V Thakkar, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Heart Association, American Medical Association, American Stroke Association, and Minnesota Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Adam E Schussheim, MD  Consulting Staff, Department of Internal Medicine, Bridgeport Hospital of the Yale-New Haven Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Justin D Pearlman, MD, PhD, ME, MA  Chief, Division of Cardiology, Director of Cardiology Consultative Service, Director of Cardiology Clinic Service, Director of Cardiology Non-Invasive Laboratory, Director of Cardiology Quality Program KMC, Dartmouth-Hitchcock Medical Center, Dartmouth Medical School

Justin D Pearlman, MD, PhD, ME, MA is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Federation for Medical Research, International Society for Magnetic Resonance in Medicine, and Radiological Society of North America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Marschall S Runge, MD, PhD  Charles and Anne Sanders Distinguished Professor of Medicine, Chairman, Department of Medicine, Vice Dean for Clinical Affairs, University of North Carolina at Chapel Hill School of Medicine

Marschall S Runge, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Federation for Medical Research, American Heart Association, American Physiological Society, American Society for Clinical Investigation, American Society for Investigative Pathology, Association of American Physicians, Association of Professors of Cardiology, Association of Professors of Medicine, Southern Society for Clinical Investigation, and Texas Medical Association

Disclosure: Pfizer Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Orthoclinica Diagnostica Consulting fee Consulting

Amer Suleman, MD  Private Practice

Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Chief Editor

Richard A Lange, MD  Professor and Executive Vice Chairman, Department of Medicine, Director, Office of Educational Programs, University of Texas Health Science Center at San Antonio

Richard A Lange, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, and Association of Subspecialty Professors

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Alan D. Forker, MD, to the development and writing of this article.

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