Medscape is available in 5 Language Editions – Choose your Edition here.


Pediatric Mitral Valve Prolapse Workup

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

Laboratory Studies

In patients with mitral valve prolapse (MVP), perform blood and other laboratory tests as dictated by the condition of the patient.

Other tests


Electrocardiography findings are usually normal; however, in about one half of children and adolescents, the findings may reveal inverted or biphasic T waves, especially in leads II, III, aVF, and/or V5-6 (see image below).[12] The T-wave abnormalities may vary at different times in the same patient and may improve with exercise or with beta-blocker therapy.

Two-lead electrocardiogram of a child with mitral Two-lead electrocardiogram of a child with mitral valve prolapse (MVP) showing T-Wave inversion in leads III and aVF.

Arrhythmias described at rest or during exercise include premature atrial (23.6%) or ventricular (27.3%) contractions, supraventricular tachycardia, and conduction abnormalities. Patients with mitral valve prolapse demonstrate a higher frequency of left-sided accessory pathways. More serious findings include ventricular tachycardia and fibrillation.

A higher incidence of arrhythmia may be due to a prolonged QT interval. Diastolic depolarization of muscle fibers in the anterior mitral leaflet in response to stretch may also have a role.

Slow response action potentials originating in the atrial-like muscle fibers in the mitral valve leaflets can lead to sustained rhythmic action that penetrates the cardiac chambers.


This was previously used as an adjunct to confirm the auscultatory findings.


Imaging Studies


Chest radiography findings are normal. Cardiac size and pulmonary venous congestion appear when mitral regurgitation (MR) is severe. The image below depicts a radiograph of a 5-year-old girl with mitral valve prolapse.

Chest radiograph of 5-year-old girl with mitral va Chest radiograph of 5-year-old girl with mitral valve prolapse (MVP) and mild mitral regurgitation. The radiograph shows cardiomegaly and normal pulmonary vasculature.

Skeletal surveys reveal any abnormalities. The image below depicts a radiograph of the left hand of a 10-year-old boy with marfanoid syndrome and mitral valve prolapse.

Plain radiograph of the left hand of a 10-year-old 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.

Echo-Doppler ultrasonographic studies

This is an essential tool to identify the presence and magnitude of mitral valve prolapse, the thickness of mitral valve leaflets, mitral annulus size, chordae tendineae length, and left ventricular and left atrial size and function. The test also reveals any associated heart diseases.[13]

Multiple views of the mitral valve annulus are essential, and the echo-Doppler findings have to be correlated with clinical data.

These studies, particularly transesophageal echocardiography, also help identify potential embolic sources in patients with focal neurologic symptoms or signs.

Findings are always interpreted in the context of the clinical evaluation by dynamic auscultation. The diagnostic accuracy improves by use of a constellation of findings, which include structural and functional changes. Patients with echocardiographic criteria for mitral valve prolapse, without evidence of thickened redundant leaflets or significant MR, require careful review before mitral valve prolapse is diagnosed. Mere sagging of anterior leaflet in the 4-chamber view does not indicate mitral valve prolapse. Patients with typical auscultatory findings may be diagnosed even with questionable echocardiographic findings.

Rarely, patients with mitral valve prolapse may have typical echocardiographic findings but no abnormality on auscultation. Patients with suggestive symptoms and no auscultatory findings, who have nonspecific echocardiographic changes, present a real challenge and may require periodic reevaluation before a firm diagnosis can be made. Family history could be of help in some of these patients.

Two- and three-dimensional studies

Two-dimensional, real-time echocardiographic pictures from parasternal long-axis window reveal the mitral valve leaflets coming together in systole and billowing into the left atrium beyond the atrioventricular junction (see image below). The medial aspect of the anterior leaflet and middle scallop of the posterior leaflet are visualized from this view. The lateral scallop of posterior leaflet can be seen only from the apical 4-chamber window, and, at times, mitral valve prolapse can be focal. The echocardiographic description of the mitral valve prolapse should include structural changes, such as leaflet thickening, redundancy, annular dilatation, and chordal elongation. A varying degree of noncoaptation of the leaflets is present, and MR can be identified by Doppler-color, pulse wave, and continuous wave. The MR jet can be defined, and its magnitude and direction estimated. The size of the left atrium and left ventricle are increased in the presence of moderate-to-severe MR.

Two-dimensional echocardiographic picture taken fr 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.

Three-dimensional echocardiography is reportedly very helpful in delineating the prolapse and associated regurgitation (see image below). Segmental analysis of the mitral valve leaflets has been as successful with this technique as with transesophageal echocardiography.[14, 15, 16] It has also been reported to provide information that helps in surgical repair.

Color-Doppler echocardiography of a child with mit Color-Doppler echocardiography of a child with mitral valve prolapse showing jet of mitral regurgitation.

Transesophageal and M-mode studies

Transesophageal echocardiography has also improved the identification of leaflet morphology, assisting surgical repair.

M-mode echocardiography reveals a characteristic posterior movement of the posterior mitral leaflet during mid or late systole or pansystolic prolapse of both anterior and posterior mitral leaflets toward the left atrium (see image below). With the availability of 2-dimensional and Doppler studies, mitral valve prolapse should no longer be diagnosed solely on M-mode pictures.

M-mode echocardiographic picture of mitral valve p M-mode echocardiographic picture of mitral valve prolapse showing pansystolic prolapse of both anterior and posterior mitral leaflets toward left atrium.

Stress scintigraphy

Myocardial perfusion scintigraphy (eg, using thallium-201) during exercise may help identify the rare patient with mitral valve prolapse and myocardial ischemia.



Ambulatory 24-hour electrocardiography

A Holter monitor may help identify the nature and frequency of arrhythmic activity. Premature ventricular beats (38%), multiform couplets, and tachyarrhythmias (8%) are usual findings.

Exercise testing

This is useful in patients with palpitations and exercise-related symptoms. Premature ventricular beats (16%), ventricular tachycardia (4%), and supraventricular ectopy are common findings. Ventricular fibrillation is a rare finding.

Cardiac catheterization and angiography

These tests are generally restricted to patients with mitral valve prolapse and severe MR who may require valve repair or replacement. Associated coronary artery disease can also be confirmed or excluded.

A left ventricular angiogram, obtained in the right anterior oblique view, best shows the posterior leaflet. A left anterior oblique projection reveals the anterior leaflet.

Other abnormalities that may be revealed include dilatation, decreased systolic contraction, calcification of the mitral annulus, and poor contraction of the basal portion of the left ventricle.


Indications for electrophysiology (EPS) are similar to those in general clinical practice. EPS is useful in the presence of supraventricular tachycardia because accessory atrioventricular pathways are common in patients with mitral valve prolapse. In this subset of patients, EPS is important because radiofrequency ablation can be performed during the same procedure, with a very high curative success rate.

Tilt test

Upright tilt studies with blood pressure and cardiac rhythm monitoring may be valuable in patients with light-headedness or syncope when vasodepressor-vasovagal reaction is suspected and confirmation of clinical symptoms is desired.


Histologic Findings

Mitral valves excised from patients with severe MR secondary to mitral valve prolapse have large leaflets and show various alterations.

The most specific, fundamental, and characteristic histologic changes are (1) collagen dissolution and disruption in the pars fibrosa of the mitral valve leaflet and (2) replacement of the dense collagenous fibrosa by loose myxomatous connective tissue with high acid mucopolysaccharide content. Similar histologic abnormalities are observed in chordae tendineae.

Scanning electron photomicrographs demonstrate surface folds and focal loss of endothelial cells on mitral valve leaflets obtained from patients with severe mitral valve prolapse and significant MR. These surface abnormalities may predispose to thromboembolic complications and/or infectious endocarditis.

Continuous pressure and stress on the leaflets and chordae tendineae during left ventricular systole contribute to gradual progression of these histologic changes.

Contributor Information and Disclosures

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.

  1. Taub CC, Stoler JM, Perez-Sanz T, et al. Mitral valve prolapse in Marfan syndrome: an old topic revisited. Echocardiography. 2009 Apr. 26(4):357-64. [Medline].

  2. Lou XF, Yang DY, Liu ZY, Wang HL, Li TS. [Clinical analysis of 120 cases of infective endocarditis]. Zhonghua Nei Ke Za Zhi. 2009 Jan. 48(1):35-8. [Medline].

  3. Grau JB, Pirelli L, Yu PJ, Galloway AC, Ostrer H. The genetics of mitral valve prolapse. Clin Genet. 2007 Oct. 72(4):288-95. [Medline].

  4. Movahed MR, Hepner AD. Mitral valvar prolapse is significantly associated with low body mass index in addition to mitral and tricuspid regurgitation. Cardiol Young. 2007 Apr. 17(2):172-4. [Medline].

  5. Attias D, Stheneur C, Roy C, et al. Comparison of clinical presentations and outcomes between patients with TGFBR2 and FBN1 mutations in Marfan syndrome and related disorders. Circulation. 2009 Dec 22. 120(25):2541-9. [Medline].

  6. Yahalom M, Spitz M, Sandler L, Heno N, Roguin N, Turgeman Y. The significance of bradycardia in anorexia nervosa. Int J Angiol. 2013 Jun. 22(2):83-94. [Medline].

  7. Hepner AD, Ahmadi-Kashani M, Movahed MR. The prevalence of mitral valve prolapse in patients undergoing echocardiography for clinical reason. Int J Cardiol. 2007 Dec 15. 123(1):55-7. [Medline].

  8. Cheunsuchon P, Chuangsuwanich T, Samanthai N, Warnnissorn M, Leksrisakul P, Thongcharoen P. Surgical pathology and etiology of 278 surgically removed mitral valves with pure regurgitation in Thailand. Cardiovasc Pathol. 2007 Mar-Apr. 16(2):104-10. [Medline].

  9. Deng YB, Takenaka K, Sakamoto T, et al. Follow-up in mitral valve prolapse by phonocardiography, M-mode and two-dimensional echocardiography and Doppler echocardiography. Am J Cardiol. 1990 Feb 1. 65(5):349-54. [Medline].

  10. Cetinkaya M, Semizel E, Bostan O, Cil E. Risk of vasovagal syncope and cardiac arrhythmias in children with mitral valve prolapse. Acta Cardiol. 2008 Jun. 63(3):395-8. [Medline].

  11. Bajracharya P, Bhatnagar S, Pauliks LB. Mitral valve diseases in Williams syndrome-case report and review of the literature. Echocardiography. 2011 Sep. 28(8):E156-9. [Medline].

  12. Markiewicz-Loskot G, Loskot M, Moric-Janiszewska E, et al. Electrocardiographic abnormalities in young athletes with mitral valve prolapse. Clin Cardiol. 2009 Aug. 32(8):E36-9. [Medline].

  13. Atalay S, Ucar T, Ozcelik N, Ekici F, Tutar E. Echocardiographic evaluation of mitral valve in patients with pure rheumatic mitral regurgitation. Turk J Pediatr. 2007 Apr-Jun. 49(2):148-53. [Medline].

  14. Gutierrez-Chico JL, Zamorano Gomez JL, Rodrigo-Lopez JL, et al. Accuracy of real-time 3-dimensional echocardiography in the assessment of mitral prolapse. Is transesophageal echocardiography still mandatory?. Am Heart J. 2008 Apr. 155(4):694-8. [Medline].

  15. Seliem MA, Fedec A, Szwast A, et al. Atrioventricular valve morphology and dynamics in congenital heart disease as imaged with real-time 3-dimensional matrix-array echocardiography: comparison with 2-dimensional imaging and surgical findings. J Am Soc Echocardiogr. 2007 Jul. 20(7):869-76. [Medline].

  16. Beraud AS, Schnittger I, Miller DC, Liang DH. Multiplanar reconstruction of three-dimensional transthoracic echocardiography improves the presurgical assessment of mitral prolapse. J Am Soc Echocardiogr. 2009 Aug. 22(8):907-13. [Medline].

  17. [Guideline] American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation. 2006 Aug 1. 114(5):e84-231. [Medline].

  18. Boon R, Hazekamp M, Hoohenkerk G, et al. Artificial chordae for pediatric mitral and tricuspid valve repair. Eur J Cardiothorac Surg. 2007 Jul. 32(1):143-8. [Medline].

  19. Miura T, Eishi K, Yamachika S, et al. Mitral valve repair for degenerative disease with leaflet prolapse: to improve long-term outcomes. Gen Thorac Cardiovasc Surg. 2009 Jan. 57(1):10-21. [Medline].

  20. Zegdi R, Sleilaty G, Latremouille C, et al. Reoperation for failure of mitral valve repair in degenerative disease: a single-center experience. Ann Thorac Surg. 2008 Nov. 86(5):1480-4. [Medline].

  21. Tacoy G, Balcioglu AS, Arslan U, et al. Effect of metoprolol on heart rate variability in symptomatic patients with mitral valve prolapse. Am J Cardiol. 2007 Jun 1. 99(11):1568-70. [Medline].

  22. AAP. Mitral valve prolapse and athletic participation in children and adolescents. Pediatrics. 1995 May. 95(5):789-90. [Medline].

  23. Bassili A, Mokhtar SA, Dabous NI, et al. Congenital heart disease among school children in Alexandria, Egypt: an overview on prevalence and relative frequencies. J Trop Pediatr. 2000 Dec. 46(6):357-62. [Medline].

  24. Beroukhim RS, Reed JH, Schaffer MS, Yetman AT. Surgical correction of mitral valve prolapse : a cure for recurrent ventricular tachycardia in Marfan syndrome?. Pediatr Cardiol. 2006 Nov-Dec. 27(6):755-8. [Medline].

  25. Bisset GS, Schwartz DC, Meyer RA, et al. Clinical spectrum and long-term follow-up of isolated mitral valve prolapse in 119 children. Circulation. 1980 Aug. 62(2):423-9. [Medline].

  26. Blum A, Shapira Y, Yeganh S, Rabinkov M. Mitral valve prolapse and thromboembolic events. Isr Med Assoc J. 2001 Apr. 3(4):282-3. [Medline].

  27. Carolei A, Marini C, Ferranti E, et al. A prospective study of cerebral ischemia in the young. Analysis of pathogenic determinants. The National Research Council Study Group. Stroke. 1993 Mar. 24(3):362-7. [Medline].

  28. Chauvaud S. Congenital mitral valve surgery: techniques and results. Curr Opin Cardiol. 2006 Mar. 21(2):95-9. [Medline].

  29. Cheng TO. Heart rate variability and QT dispersion in mitral valve prolapse. J Electrocardiol. 2001 Jan. 34(1):89. [Medline].

  30. Cheng TO, Wang XF, Zheng LH, Li ZA, Lu P. Three-dimensional transesophageal echocardiography in the diagnosis of mitral valve prolapse. Am Heart J. 1994 Dec. 128(6 Pt 1):1218-24. [Medline].

  31. Chou HT, Chen YT, Shi YR, Tsai FJ. Association between angiotensin I-converting enzyme gene insertion/deletion polymorphism and mitral valve prolapse syndrome. Am Heart J. 2003 Jan. 145(1):169-73. [Medline].

  32. Chou HT, Hung JS, Chen YT, Shi YR, Tsai FJ. Association between angiotensinogen gene M235T polymorphism and mitral valve prolapse syndrome in Taiwan Chinese. J Heart Valve Dis. 2002 Nov. 11(6):830-6. [Medline].

  33. Chou HT, Shi YR, Hsu Y, Tsai FJ. Association between fibrillin-1 gene exon 15 and 27 polymorphisms and risk of mitral valve prolapse. J Heart Valve Dis. 2003 Jul. 12(4):475-81. [Medline].

  34. Colomina MJ, Puig L, Godet C, Villanueva C, Bago J. Prevalence of asymptomatic cardiac valve anomalies in idiopathic scoliosis. Pediatr Cardiol. 2002 Jul-Aug. 23(4):426-9. [Medline].

  35. Cooke RA, Chambers JB. Anorexia nervosa and the heart. Br J Hosp Med. 1995 Oct 4-17. 54(7):313-7. [Medline].

  36. Corrado D, Basso C, Nava A, Rossi L, Thiene G. Sudden death in young people with apparently isolated mitral valve prolapse. G Ital Cardiol. 1997 Nov. 27(11):1097-105. [Medline].

  37. Corrado D, Thiene G, Nava A, Rossi L, Pennelli N. Sudden death in young competitive athletes: clinicopathologic correlations in 22 cases. Am J Med. 1990 Nov. 89(5):588-96. [Medline].

  38. Corrao S, Scaglione R, Arnone S, Licata G. Left ventricular diastolic filling alterations in subjects with mitral valve prolapse: a Doppler echocardiographic study. Eur Heart J. 1993 Mar. 14(3):369-72. [Medline].

  39. David TE, Omran A, Armstrong S, Sun Z, Ivanov J. Long-term results of mitral valve repair for myxomatous disease with and without chordal replacement with expanded polytetrafluoroethylene sutures. J Thorac Cardiovasc Surg. 1998 Jun. 115(6):1279-85; discussion 1285-6. [Medline].

  40. Dreyfus GD, Corbi P, Rubin S, Aubert S. Posterior leaflet preservation in mitral valve prolapse: a new approach to mitral repair. J Heart Valve Dis. 2006 Jul. 15(4):528-30. [Medline].

  41. Freed LA, Acierno JS, Dai D, et al. A locus for autosomal dominant mitral valve prolapse on chromosome 11p15.4. Am J Hum Genet. 2003 Jun. 72(6):1551-9. [Medline].

  42. Fuzellier JF, Chauvaud SM, Fornes P, et al. Surgical management of mitral regurgitation associated with Marfan's syndrome. Ann Thorac Surg. 1998 Jul. 66(1):68-72. [Medline].

  43. Glesby MJ, Pyeritz RE. Association of mitral valve prolapse and systemic abnormalities of connective tissue. A phenotypic continuum. JAMA. 1989 Jul 28. 262(4):523-8. [Medline].

  44. Gorgulu S, Eren M, Norgaz T, Tezel T. Comparison of echocardiographic methods in assessing severity of mitral regurgitation in patients with mitral valve prolapse. J Heart Valve Dis. 2004 Jan. 13(1):38-45. [Medline].

  45. Hamada T, Koshino Y, Misawa T, Isaki K, Gejyo F. Mitral valve prolapse and autonomic function in panic disorder. Acta Psychiatr Scand. 1998 Feb. 97(2):139-43. [Medline].

  46. Henneke KH, Pongratz G, Feistel H, et al. Assessment of cardiac adrenergic supply in mitral valve prolapse using m-[123I]iodobenzylguanidine scintigraphy. Int J Cardiol. 1992 Dec. 37(3):389-94. [Medline].

  47. Ismajli J, Shabani X, Manaj R, Emini M, Bajraktari G. Mitral valve prolapse, atrial flutter, and syncope in a young female patient. Med Sci Monit. 2006 Nov. 12(11):CS110-3. [Medline].

  48. James PA, Aftimos S, Skinner JR. Familial mitral valve prolapse associated with short stature, characteristic face, and sudden death. Am J Med Genet A. 2003 May 15. 119(1):32-6. [Medline].

  49. Kaminer SJ, Hixon RL, Strong WB. Evaluation and recommendations for participation in athletics for children with heart disease. Curr Opin Pediatr. 1995 Oct. 7(5):595-600. [Medline].

  50. Karakurum B, Topcu S, Yildirim T, Karatas M, Turan I, Tan M. Silent cerebral infarct in patients with mitral valve prolapse. Int J Neurosci. 2005 Nov. 115(11):1527-37. [Medline].

  51. Karavidas AI, Lazaros GA, Zampoulakis JD, et al. Prevalence of mitral valve prolapse and thick mitral valve in a non-selected outpatient population. Cardiology. 2002. 98(3):165-6. [Medline].

  52. Kasegawa H, Shimokawa T, Shibazaki I, Hayashi H, Koyanagi T, Ida T. Mitral valve repair for anterior leaflet prolapse with expanded polytetrafluoroethylene sutures. Ann Thorac Surg. 2006 May. 81(5):1625-31. [Medline].

  53. Katsanos KH, Pappas CJ, Patsouras D, et al. Alarming atrioventricular block and mitral valve prolapse in the Kearns-Sayre syndrome. Int J Cardiol. 2002 May. 83(2):179-81. [Medline].

  54. Kim S, Kuroda T, Nishinaga M, et al. Relationship between severity of mitral regurgitation and prognosis of mitral valve prolapse: echocardiographic follow-up study. Am Heart J. 1996 Aug. 132(2 Pt 1):348-55. [Medline].

  55. Kitlinski M, Stepniewski M, Nessler J, et al. Is magnesium deficit in lymphocytes a part of the mitral valve prolapse syndrome?. Magnes Res. 2004 Mar. 17(1):39-45. [Medline].

  56. Kligfield P, Devereux RB. Arrhythmia in mitral valve prolapse. Podrid PR, Kowey PR eds. Cardiac arrhythmia: mechanisms, diagnosis and management. Baltimore, Md: Williams and Wilkins; 1995. 1253-65.

  57. Komoda T, Hubler M, Siniawski H, Hetzer R. Annular stabilization in mitral repair without a prosthetic ring. J Heart Valve Dis. 2000 Nov. 9(6):776-82. [Medline].

  58. Koutlianos NA, Kouidi EJ, Metaxas TI, Deligiannis AP. Non-invasive cardiac electrophysiological indices in soccer players with mitral valve prolapse. Eur J Cardiovasc Prev Rehabil. 2004 Oct. 11(5):435-41. [Medline].

  59. Kulan K, Komsuoglu B, Tuncer C. Significance of QT dispersion on ventricular arrhythmias in mitral valve prolapse. Int J Cardiol. 1996 Jun. 54(3):251-7. [Medline].

  60. Lichodziejewska B, Klos J, Rezler J, et al. Clinical symptoms of mitral valve prolapse are related to hypomagnesemia and attenuated by magnesium supplementation. Am J Cardiol. 1997 Mar 15. 79(6):768-72. [Medline].

  61. Loupa C, Mavroidi N, Boutsikakis, et al. Infective endocarditis in Greece: a changing profile. Epidemiological, microbiological and therapeutic data. Clin Microbiol Infect. 2004 Jun. 10(6):556-61. [Medline].

  62. Lumiaho A, Ikaheimo R, Miettinen R, et al. Mitral valve prolapse and mitral regurgitation are common in patients with polycystic kidney disease type 1. Am J Kidney Dis. 2001 Dec. 38(6):1208-16. [Medline].

  63. Malkowski MJ, Guo R, Orsinelli DA, et al. The morphologic characteristics of flail mitral leaflets by transesophageal echocardiography. J Heart Valve Dis. 1997 Jan. 6(1):54-9. [Medline].

  64. Marks AR, Choong CY, Sanfilippo AJ, et al. Identification of high-risk and low-risk subgroups of patients with mitral-valve prolapse. N Engl J Med. 1989 Apr 20. 320(16):1031-6. [Medline].

  65. McDonnell NB, Gorman BL, Mandel KW, Schurman SH, Assanah-Carroll A, Mayer SA. Echocardiographic findings in classical and hypermobile Ehlers-Danlos syndromes. Am J Med Genet A. 2006 Jan 15. 140(2):129-36. [Medline].

  66. Micieli G, Cavallini A, Melzi d'Eril GV, et al. Haemodynamic and neurohormonal responsiveness to different stress tests in mitral valve prolapse. Clin Auton Res. 1991 Dec. 1(4):323-7. [Medline].

  67. Muller S, Muller L, Laufer G, et al. Comparison of three-dimensional imaging to transesophageal echocardiography for preoperative evaluation in mitral valve prolapse. Am J Cardiol. 2006 Jul 15. 98(2):243-8. [Medline].

  68. Murakami T, Yagihara T, Yamamoto F, et al. Artificial chordae for mitral valve reconstruction in children. Ann Thorac Surg. 1998 May. 65(5):1377-80. [Medline].

  69. Nascimento R, Freitas A, Teixeira F, et al. Is mitral valve prolapse a congenital or acquired disease?. Am J Cardiol. 1997 Jan 15. 79(2):226-7. [Medline].

  70. Oke DA, Ajuluchukwu JN, Mbakwem A, et al. Clinical and echocardiographic assessment of Nigerian patients seen at the Lagos University Teaching Hospital with features of mitral valve prolapse. West Afr J Med. 2000 Jul-Sep. 19(3):200-5. [Medline].

  71. Panther R, Mahmood S, Gal R. Echocardiography in the diagnostic evaluation of syncope. J Am Soc Echocardiogr. 1998 Mar. 11(3):294-8. [Medline].

  72. Patel V, Hsiung MC, Nanda NC, et al. Usefulness of live/real time three-dimensional transthoracic echocardiography in the identification of individual segment/scallop prolapse of the mitral valve. Echocardiography. 2006 Jul. 23(6):513-8. [Medline].

  73. Pini R, Greppi B, Roman MJ, et al. Time-motion reconstruction of mitral leaflet motion from two-dimensional echocardiography in mitral valve prolapse. Am J Cardiol. 1991 Jul 15. 68(2):215-20. [Medline].

  74. Rezaian GR, Emad A. Mitral valve prolapse in patients with pure rheumatic mitral stenosis: an angiographic study. Angiology. 2001 Apr. 52(4):267-71. [Medline].

  75. Ronneberger DL, Hausmann R, Betz P. Sudden death associated with myxomatous transformation of the mitral valve in an 8-year-old boy. Int J Legal Med. 1998. 111(4):199-201. [Medline].

  76. Savage DD, Devereux RB, Garrison RJ, et al. Mitral valve prolapse in the general population. 2. Clinical features: the Framingham Study. Am Heart J. 1983 Sep. 106(3):577-81. [Medline].

  77. Seliem MA, Duffy CE, Gidding SS, et al. Echocardiographic evaluation of the aortic root and mitral valve in children and adolescents with isolated pectus excavatum: comparison with Marfan patients. Pediatr Cardiol. 1992 Jan. 13(1):20-3. [Medline].

  78. Smedira NG, Selman R, Cosgrove DM, et al. Repair of anterior leaflet prolapse: chordal transfer is superior to chordal shortening. J Thorac Cardiovasc Surg. 1996 Aug. 112(2):287-91; discussion 291-2. [Medline].

  79. Stoddard MF, Prince CR, Dillon S, et al. Exercise-induced mitral regurgitation is a predictor of morbid events in subjects with mitral valve prolapse. J Am Coll Cardiol. 1995 Mar 1. 25(3):693-9. [Medline].

  80. Strom BL, Abrutyn E, Berlin JA, et al. Dental and cardiac risk factors for infective endocarditis. A population-based, case-control study. Ann Intern Med. 1998 Nov 15. 129(10):761-9. [Medline].

  81. Suchon E, Podolec P, Plazak W, et al. Mitral valve prolapse associated with ostium secundum atrial septal defect--a functional disorder. Acta Cardiol. 2004 Apr. 59(2):237-8. [Medline].

  82. Suri RM, Schaff HV, Dearani JA, et al. Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg. 2006 Sep. 82(3):819-26. [Medline].

  83. Tayel S, Kurczynski TW, Levine M, et al. Marfanoid children. Etiologic heterogeneity and cardiac findings. Am J Dis Child. 1991 Jan. 145(1):90-3. [Medline].

  84. Terechtchenko L, Doronina SA, Pochinok EM, Riftine A. Autonomic tone in patients with supraventricular arrhythmia associated with mitral valve prolapse in young men. Pacing Clin Electrophysiol. 2003 Jan. 26(1 Pt 2):444-6. [Medline].

  85. Toren P, Eldar S, Cendorf D, et al. The prevalence of mitral valve prolapse in children with anxiety disorders. J Psychiatr Res. 1999 Jul-Aug. 33(4):357-61. [Medline].

  86. Van Der Ham DP, De Vries JK, Van Der Merwe PL. Mitral valve prolapse: a study of 45 children. Cardiovasc J S Afr. 2003 Jul-Aug. 14(4):191-4. [Medline].

  87. Venugopalan P, Agarwal AK, Johnston WJ, Riveria E. Spread of heart diseases seen in an open-access paediatric echocardiography clinic. Int J Cardiol. 2002 Aug. 84(2-3):211-6. [Medline].

  88. Venugopalan P, Joshi SN. Cardiac involvement in infantile Sandhoff disease. J Paediatr Child Health. 2002 Feb. 38(1):98-100. [Medline].

  89. Wilson W, Taubert KA, Gewitz M, et al. Prevention of Infective Endocarditis. Guidelines From the American Heart Association. A Guideline From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007 Apr 19. [Medline].

  90. Woolf PK, Gewitz MH, Berezin S, et al. Noncardiac chest pain in adolescents and children with mitral valve prolapse. J Adolesc Health. 1991 May. 12(3):247-50. [Medline].

  91. Wu MH, Lue HC, Wang JK, Wu JM. Implications of mitral valve prolapse in children with rheumatic mitral regurgitation. J Am Coll Cardiol. 1994 Apr. 23(5):1199-203. [Medline].

  92. Zuppiroli A, Mori F, Favilli S, et al. "Natural histories" of mitral valve prolapse. Influence of patient selection on cardiovascular event rates. Ital Heart J. 2001 Feb. 2(2):107-14. [Medline].

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.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.