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Pediatric Mitral Valve Prolapse Differential Diagnoses

  • Author: Poothirikovil Venugopalan, MBBS, MD, FRCPCH; Chief Editor: P Syamasundar Rao, MD  more...
 
Updated: Feb 21, 2014
 
 

Diagnostic Considerations

Important considerations

Note the following:

  • Do not fail to make the diagnosis
  • Do not fail to fully investigate patients who are symptomatic
  • Restrict exercise in patients who are symptomatic
  • Recognize the higher risk of arrhythmia during anesthesia and the perioperative period
  • Properly interpret findings: Patients with mitral valve prolapse (MVP) syndrome require a careful history and thorough physical examination because of the possibility of misinterpreting history, physical findings, borderline laboratory test results, and nonspecific ECG or echocardiography changes.
  • Avoid overtreatment

Special concerns

The diagnosis should include the type of prolapse (late systolic, holosystolic, anterior, or posterior leaflet), thickness of mitral valve leaflets, size of mitral annulus, and the left ventricular and left atrial size and function. The diagnosis should also include presence, severity, and timing of mitral regurgitation (MR); define jet direction and magnitude; and clearly list associated abnormalities.

Patients with orthostatic syncope secondary to dehydration should take excess salt and water during and following sport activities and competition.

Patients are more sensitive to volume depletion; hence chronic diuretic therapy should be avoided.

Other problems to be considered

Also consider the following conditions in patients with suspected mitral valve prolapse:

  • Congenital mitral regurgitation
  • Rheumatic mitral regurgitation
  • Tricuspid valve prolapse

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Poothirikovil Venugopalan, MBBS, MD, FRCPCH Consultant Pediatrician with Cardiology Expertise, Department of Child Health, Brighton and Sussex University Hospitals, NHS Trust; Honorary Senior Clinical Lecturer, Brighton and Sussex Medical School, UK

Poothirikovil Venugopalan, MBBS, MD, FRCPCH is a member of the following medical societies: Royal College of Paediatrics and Child Health, Paediatrician with Cardiology Expertise Special Interest Group, British Congenital Cardiac Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Julian M Stewart, MD, PhD Associate Chairman of Pediatrics, Director, Center for Hypotension, Westchester Medical Center; Professor of Pediatrics and Physiology, New York Medical College

Julian M Stewart, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Autonomic Society, American Physiological Society

Disclosure: Received grant/research funds from Lundbeck Pharmaceuticals for none.

Chief Editor

P Syamasundar Rao, MD Professor of Pediatrics and Medicine, Division of Cardiology, Emeritus Chief of Pediatric Cardiology, University of Texas Medical School at Houston and Children's Memorial Hermann Hospital

P Syamasundar Rao, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography and Interventions, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Charles I Berul, MD Professor of Pediatrics and Integrative Systems Biology, George Washington University School of Medicine; Chief, Division of Cardiology, Children's National Medical Center

Charles I Berul, MD is a member of the following medical societies: American Academy of Pediatrics, Heart Rhythm Society, Cardiac Electrophysiology Society, Pediatric and Congenital Electrophysiology Society, American College of Cardiology, American Heart Association, Society for Pediatric Research

Disclosure: Received grant/research funds from Medtronic for consulting.

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Chest radiograph of 5-year-old girl with mitral valve prolapse (MVP) and mild mitral regurgitation. The radiograph shows cardiomegaly and normal pulmonary vasculature.
Two-lead electrocardiogram of a child with mitral valve prolapse (MVP) showing T-Wave inversion in leads III and aVF.
Two-dimensional echocardiographic picture taken from the parasternal long-axis view showing prolapse of both anterior and posterior mitral valve leaflets into the left atrium at systole.
Color-Doppler echocardiography of a child with mitral valve prolapse showing jet of mitral regurgitation.
M-mode echocardiographic picture of mitral valve prolapse showing pansystolic prolapse of both anterior and posterior mitral leaflets toward left atrium.
Plain radiograph of the left hand of a 10-year-old boy with marfanoid syndrome and mitral valve prolapse (MVP) showing the long thin metacarpals. The metacarpal index is longer than normal.
 
 
 
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