Mitral valve prolapse (MVP), also known as Barlow syndrome, is often defined as systolic bowing of the mitral leaflet more than 2 mm beyond the annular plane into the atrium 1. It is a common cause of mitral regurgitation (considered most frequent cause of severe non-ischemic mitral regurgitation 2).
Mitral valve prolapse may affect up to 2-3% of the general population 3. Although often isolated it is also seen in individuals with connective tissue disorders. Another important association is adult polycystic kidney disease.
Mitral valve prolapse is often asymptomatic, however some patients may experience atypical chest pain and palpitations. On cardiac auscultation, a characteristic late systolic murmur with mid-systolic click may be audible in the mitral region.
Mitral leaflet bowing is caused by rupture or elongation of the chordae tendineae (often due to myxomatous degeneration). The middle scallop of the posterior leaflet (P2 segment) is most often affected.
Ultrasound / echocardiography
In mitral valve prolapse, the coaptation line lies behind the annular plane. On 2D echo, the diagnosis of a prolapse should be made in the parasternal or eventually the apical long-axis view and not on an apical four-chamber view, as the saddle shaped annulus could lead to a false positive diagnosis 5.
Treatment and prognosis
It is usually repaired surgically.
- 1. Morris MF, Maleszewski JJ, Suri RM et-al. CT and MR imaging of the mitral valve: radiologic-pathologic correlation. Radiographics. 2010;30 (6): 1603-20. doi:10.1148/rg.306105518 - Pubmed citation
- 2. Koo HJ, Yang DH, Oh SY et-al. Demonstration of mitral valve prolapse with CT for planning of mitral valve repair. Radiographics. 2014;34 (6): 1537-52. doi:10.1148/rg.346130146 - Pubmed citation
- 3. Han Y, Peters DC, Salton CJ et-al. Cardiovascular magnetic resonance characterization of mitral valve prolapse. JACC Cardiovasc Imaging. 2008;1 (3): 294-303. doi:10.1016/j.jcmg.2008.01.013 - Pubmed citation
- 4. Chen JJ, Manning MA, Frazier AA et-al. CT angiography of the cardiac valves: normal, diseased, and postoperative appearances. Radiographics. 2009;29 (5): 1393-412. Radiographics (full text) - doi:10.1148/rg.295095002 - Pubmed citation
- 5. Lancellotti, Patrizio, Moura, Luis, Pierard, Luc A., Agricola, Eustachio, Popescu, Bogdan A., Tribouilloy, Christophe, Hagendorff, Andreas, Monin, Jean-Luc, Badano, Luigi, Zamorano, Jose L., Sicari, Rosa, Vahanian, Alec, Roelandt, Jos R.T.C.. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). (2010) European Journal of Echocardiography. 11 (4): 307. doi:10.1093/ejechocard/jeq031