Mitral Valve Prolapse

Definition

Mitral valve prolapse (MVP) is a valvular heart disease characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole .

It results from myxomatous degeneration secondary to collagen dissolution resulting in stretching of the leaflets and the chordae tendineae. It is seen in association with aortic disease in Marfan’s and annuloaortic ectasia as well as the Ehlos Danlos syndrome.

Structurally collagen dissolution leads to excess mucopolysaccharides in the middle spongiosa layer of the mitral valve leaflets.

Functionally there may be a mitral regurgitation.

Clinically most patients are asymptomatic. Some patients develop supraventricular arrhythmias, palpitations, mitral regurgitation, bacterial endocarditis, and sudden death.

Diagnosis is made by echocardiography.

Treatment is usually reassurance in most cases.

Isolated Prolapse of the Posterior Leaflet

Billowing Mitral Valve

This angiogram of the heart in RAO projection demonstrates billowing of the posterior leaflet of the mitral valve (green overlay) with a small jet of mitral regurgitation into the left atrium.C

Courtesy Ashley Davidoff 34811b code cardiac heart mitral valve posterior leaflet prolapse MVP Barlow’s syndrome MR mitral incopetence MV imaging radiology angiography disease overlay

Prolapse of Anterior and Posterior Leaflet of the Mitral Valve

Marfan’s Syndrome with Aortic Disease

This angiogram in RAO projection shows prolapse of both the anterior and posterior leaflets of the mitral valve with mitral regurgitation. Note also the bulbous appearance of the aortic sinuses. The back wall of the left atrium is flattened against the spine suggesting a narrow A-P diameter or pectus excavatum. These findings are characteristic of Maran’s syndrome Courtesy Ashley DAvidoff MD.

34810c code cardiac heart mitral valve MV anterior leaflet posterior leaflet prolapse mitral regurgitation MR incompetence aorta Marfan’s syndrome floppy mitral valve angiography LA shape MVP imaging radiology angiography disease overlay radiologists and detectives