Mitral Valve Prolapse Treatment & Management

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

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 or 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.
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Surgical Care

See the surgical management discussion in Mitral Regurgitation.

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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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