eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiology

Mitral Valve Prolapse: Follow-up

Author: Poothirikovil Venugopalan, MBBS, MD, FRCP (Glasg), FRCPCH, Consulting Staff, Department of Child Health, University Hospital of Hartlepool, UK
Contributor Information and Disclosures

Updated: Oct 8, 2008

Follow-up

Further Inpatient Care

  • Admission of patients with mitral valve prolapse (MVP) is seldom required, except in the case of complications or for consideration of surgical intervention.

Further Outpatient Care

  • Patients require continued follow-up care and evaluation into adult life.
  • Repeat evaluations every 3-5 years to identify any progression.
  • Infective endocarditis prophylaxis is indicated in patients with mitral valve prolapse and mitral regurgitation (MR) while undergoing at-risk procedures. For more information, see Antibiotic Prophylaxis Regimens for Endocarditis.
  • Patients with accessory pathways should have detailed electrophysiology studies and radiofrequency ablation of the accessory pathway.
  • Coronary artery anomalies should be excluded in patients with chest pain before they participate in sports.
  • Mild prolapse on echocardiography, in the absence of clinical findings (15-20% of patients), does not indicate true mitral valve prolapse syndrome. Parents and patients need to be reassured.

Inpatient & Outpatient Medications

  • Anti–heart failure medications
  • Propranolol
  • Aspirin
  • Dipyridamole
  • Warfarin
  • Antibiotics for endocarditis prophylaxis

Complications

  • MR: Progression or appearance of MR is one of the main complications. Over 4.3 years, approximately 14% of patients developed MR.
  • Congestive cardiac failure
  • Rupture of chordae tendineae
  • Infective endocarditis, in 0.1-0.3 cases per 100 patient years
  • Thromboembolic phenomena including cerebrovascular accidents and sudden death
  • Cardiac arrhythmia
  • Ventricular tachycardia and fibrillation

Prognosis

  • The condition is not progressive in childhood, and specific therapy is not indicated for the vast majority of patients.
  • Progression to significant MR or sudden death is rare.
  • Asymptomatic patients with isolated mitral systolic clicks need only counseling and reassurance.

Patient Education

  • Careful explanation of the clinical findings and the nature of mitral valve prolapse help to reassure the anxious patient.
  • Normal activity can be allowed if MR is not severe
  • Antibiotic prophylaxis during surgery and dental procedures is only necessary if associated MR is present.
  • The vast majority of patients with MVP remain asymptomatic for their entire lives and require observation every few years for reassurance.
  • Patients with orthostatic syncope secondary to dehydration should take extra salt and water during and following sport activities and competition.
  • Pregnancy requires infective endocarditis prophylaxis during delivery. Other implications are based on the severity of MR.
  • For excellent patient education resources, visit eMedicine's Heart Center. Also, see eMedicine's patient education article Mitral Valve Prolapse.

Miscellaneous

Medicolegal Pitfalls

  • Failure to make the diagnosis
  • Failure to fully investigate patients who are symptomatic
  • Failure to restrict exercise in patients who are symptomatic
  • Failure to recognize the higher risk of arrhythmia during anesthesia and the perioperative period
  • Failure to 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.
  • Overtreatment
  • Overdiagnosis
  • Failure to investigate unexplained symptoms: Any unexplained symptoms should be viewed with due concern and investigated.

Special Concerns

  • 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.
 


More on Mitral Valve Prolapse

Overview: Mitral Valve Prolapse
Differential Diagnoses & Workup: Mitral Valve Prolapse
Treatment & Medication: Mitral Valve Prolapse
Follow-up: Mitral Valve Prolapse
Multimedia: Mitral Valve Prolapse
References
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Further Reading

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Keywords

mitral valve prolapse, Barlow syndrome, billowing mitral valve syndrome, Da Costa syndrome, effort syndrome, familial MVP, floppy mitral valve syndrome, irritable heart syndrome, myxomatous mitral valve, neuro-circulatory asthenia, redundant cusp syndrome, soldier heart syndrome, systolic click-murmur syndrome, mitral regurgitation, heart failure, Marfan syndrome, Ehlers-Danlos syndrome, rheumatic fever, endocarditis, myocardial infarction, ischemia, syncope supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation, cardiac arrhythmia, panic attacks, presyncope, Stickler syndrome

polycystic kidney disease, osteogenesis imperfecta, fragile X syndrome, Martin-Bell syndrome, pseudoxanthoma elasticum, periarteritis nodosa, asthenic habitus, straight back syndrome, pectus excavatum, pectus carinatum, atrial septal defect ostium secundum, tricuspid valve prolapse, aortic valve prolapse, Ebstein anomaly, Holt-Oram syndrome, hypertrophic cardiomyopathy, Graves disease, thyroiditis, sickle cell disease, muscular dystrophy, myotonic dystrophy, Von Willebrand disease, magnesium deficiency

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Contributor Information and Disclosures

Author

Poothirikovil Venugopalan, MBBS, MD, FRCP (Glasg), FRCPCH, Consulting Staff, Department of Child Health, University Hospital of Hartlepool, UK
Poothirikovil Venugopalan, MBBS, MD, FRCP (Glasg), FRCPCH is a member of the following medical societies: British Cardiac Society, Royal College of Paediatrics and Child Health, and Royal College of Physicians and Surgeons of Glasgow
Disclosure: Nothing to disclose.

Medical Editor

Charles I Berul, MD, Associate Professor of Pediatrics, Harvard Medical School; Senior Associate, Department of Cardiology, Children's Hospital of Boston
Charles I Berul, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Heart Rhythm Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

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
Disclosure: Nothing to disclose.

CME Editor

Gilbert Herzberg, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College
Gilbert Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD, Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin
Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

 
 
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