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Mitral Valve Prolapse Treatment & Management

  • Author: Bhavik V Thakkar, MD; Chief Editor: Richard A Lange, MD, MBA  more...
Updated: Apr 23, 2014

Medical Care

Asymptomatic patients with minimal disease

These patients should be strongly reassured of their benign prognosis.

They should undergo initial echocardiography for risk stratification. If no clinically significant mitral regurgitation and thin leaflets are observed, clinical examinations and echocardiographic studies can be scheduled every 3-5 years.

These patients are encouraged to pursue a normal, unrestricted lifestyle, including vigorous exercise.

Patients with symptoms of autonomic dysfunction

A trial of beta-blockers for symptomatic relief can be recommended.

Abstinence from stimulants such as caffeine, alcohol, and cigarettes is also recommended. An ambulatory 24-hour monitor may be useful to detect supraventricular and/or ventricular arrhythmias.

Patients with evidence of progression to severe mitral regurgitation

Close follow-up and referral for surgical repair are indicated early, before left ventricular dilatation and systolic dysfunction develop.

Asymptomatic patients with moderate-to-severe mitral regurgitation and left ventricular enlargement, especially those with atrial fibrillation and/or pulmonary hypertension, should undergo surgery before left ventricular function deteriorates.

If the physician is unsure if the patient is asymptomatic, a treadmill stress test for exercise tolerance can be performed. That is, have the patient demonstrate that he or she can walk vigorously without symptoms.

Patients with MVP and neurologic findings

After atrial fibrillation and left atrial thrombus are excluded, these patients should be given daily aspirin therapy at a dosage of 80-325 mg/d.

Cessation of smoking and oral contraceptive use to prevent a hypercoagulable state should be recommended.

Warfarin should be used when patients older than 65 years have atrial fibrillation, especially if they have associated risk factors of a previous stroke or TIA, clinically significant valvular heart disease, hypertension, diabetes, left atrial enlargement, or a history and/or findings of heart failure.

Patients with a mid-systolic click and late-systolic mitral regurgitation murmur

Consider antibiotic prophylaxis in these patients, including those with increased leaflet thickening or redundancy.

Antibiotic prophylaxis is not recommended for the patient with an isolated mid-to-late systolic click without a murmur, unless the echocardiogram demonstrates significant leaflet redundancy and/or thickness.


Surgical Care

See the surgical management discussion in Mitral Regurgitation.

Contributor Information and Disclosures

Bhavik V Thakkar, MD Medical Director, Internal Medicine Hospitalist, AppleCare Medical Group

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, Minnesota Medical Association, American Stroke Association, Society for Vascular Medicine

Disclosure: Nothing to disclose.


Adam E Schussheim, MD Cardiac Specialists, PC

Adam E Schussheim, MD is a member of the following medical societies: American College of Cardiology, American Society of Echocardiography, American Society of Hypertension, American Society of Nuclear Cardiology

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 Physiological Society, American Society for Clinical Investigation, American Society for Investigative Pathology, Association of American Physicians, Texas Medical Association, Southern Society for Clinical Investigation, American Federation for Clinical Research, Association of Professors of Medicine, Association of Professors of Cardiology, American Association for the Advancement of Science, American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Federation for Medical Research, American Heart Association

Disclosure: Received honoraria from Pfizer for speaking and teaching; Received honoraria from Merck for speaking and teaching; Received consulting fee from Orthoclinica Diagnostica for consulting.

Chief Editor

Richard A Lange, MD, MBA President, Texas Tech University Health Sciences Center, Dean, Paul L Foster School of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

Justin D Pearlman, MD, ME, PhD, FACC, MA Chief, Division of Cardiology, Director of Cardiology Consultative Service, Director of Cardiology Clinic Service, Director of Cardiology Non-Invasive Laboratory, Chair of Institutional Review Board, University of California, Los Angeles, David Geffen School of Medicine

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

Disclosure: Nothing to disclose.


Alan D Forker, MD Professor of Medicine, University of Missouri at Kansas City School of Medicine; Director, Outpatient Lipid Diabetes Research, MidAmerica Heart Institute of St Luke's Hospital

Disclosure: Nothing to disclose.

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