Mitral valve prolapse

Last revised by Daniel J Bell on 16 Dec 2021

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.

In mitral valve prolapse, the coaptation line lies behind the annular plane. On 2D echo, the diagnosis of mitral 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

It is usually repaired surgically. 

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