Mitral Valve Prolapse

Diagnose MVP on transthoracic echocardiography (TTE) by systolic displacement of part of one or both mitral leaflets into the left atrium; a >2-mm displacement criterion is used in echocardiographic studies. NEJM+2NEJMMitral-Valve Repair for Mitral-Valve ProlapsejaccFunctional Implication of Mitral Annular Disjunction in Mitral Valve ...NaturePrevalence and characteristics of mitral valve prolapse in military young adults in Taiwan of the CHIEF Heart Study | Scientific Reports Document which leaflet segments prolapse, whether involvement is bileaflet or multisegmental, leaflet morphology, and the MR mechanism rather than reporting “MVP” as a stand-alone finding.

At the index evaluation, obtain history, examination, ECG, and a comprehensive TTE that reports MR severity, LV size and systolic function, left atrial size, and estimated pulmonary pressure. This separates uncomplicated MVP from primary degenerative MR with volume-overload consequences and identifies patients whose referral should focus on repair feasibility. Nature+1NatureLeft atrial size predicts outcome in severe but asymptomatic mitral regurgitation | Scientific Reportsjacc2020 Focused Update of the 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation: A Report of the American College of Cardiology Solution Set Oversight Committee

Use an integrated rather than a single-parameter MR assessment. A dense triangular continuous-wave Doppler MR profile, well-aligned MR velocity <4.5 m/s suggesting elevated left atrial pressure, otherwise unexplained LA or LV dilation, pulmonary artery systolic pressure >50 mm Hg, pulmonary-vein systolic flow reversal, and dominant mitral inflow E-wave velocity >1.2–1.5 m/s in the absence of mitral stenosis support severe MR. jaccjacc2020 Focused Update of the 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation: A Report of the American College of Cardiology Solution Set Oversight Committee

For MVP with severe primary MR, treat LVEF ≤60% or LV end-systolic diameter ≥40 mm as adverse LV thresholds. In chronic MR, an LVEF that appears numerically preserved can still reflect declining contractile reserve; therefore, do not defer a valve-team assessment until EF is frankly reduced. jaccjacc2020 Focused Update of the 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation: A Report of the American College of Cardiology Solution Set Oversight Committee

Recent-onset atrial fibrillation, pulmonary hypertension, left atrial systolic volume index >60 mL/m², EROA, and flail leaflet are prognostically important features in primary MR. Their presence should prompt reassessment of MR severity and timely evaluation of intervention strategy rather than surveillance based only on symptom status. jaccjacc2020 Focused Update of the 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation: A Report of the American College of Cardiology Solution Set Oversight Committee

When surgery is selected for degenerative MVP with severe MR, assess the likelihood of durable mitral repair as part of procedural planning. Evidence summarized in the ACC pathway associates surgery before symptoms or before LVEF ≤60% and LV end-systolic diameter ≥40 mm are reached with improved survival and functional outcomes. jaccjacc2020 Focused Update of the 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation: A Report of the American College of Cardiology Solution Set Oversight Committee

Ask specifically about unexplained syncope, exertional presyncope, sustained palpitations, documented ventricular tachycardia, and out-of-hospital arrest. In patients with concerning symptoms, abnormal ECG findings, or high-risk valve morphology, obtain ambulatory rhythm monitoring to define ventricular ectopy burden, complexity, and sustained ventricular arrhythmia; arrhythmic MVP is characterized by MVP with or without mitral annular disjunction plus frequent or complex ventricular ectopy or sustained ventricular arrhythmia when another arrhythmic substrate is not identified. jacc+1jaccArrhythmogenic Mitral Valve Prolapse: Looking Beyond ... - JACCcdn clinicaltrialsProtocol

Bileaflet and extensive multisegment prolapse are prominent in reported malignant MVP cohorts. Mitral annular disjunction should be specifically sought on imaging because it may accompany the arrhythmic phenotype and should not be dismissed as an incidental descriptive finding in a patient with ventricular ectopy or syncope. BMJ+2BMJMitral valve and left ventricular features in malignant ... - Open HeartjaccFunctional Implication of Mitral Annular Disjunction in Mitral Valve ...cdn clinicaltrialsProtocol

Escalate imaging evaluation when the rhythm phenotype or valve morphology is concerning. Papillary-muscle fibrosis was present histologically in all cases in one sudden-death series with arrhythmic MVP, linking ventricular arrhythmia assessment to a search for myocardial substrate rather than to MR grading alone. AHA JournalsAHA JournalsArrhythmic Mitral Valve Prolapse and Sudden Cardiac Death Cardiac magnetic resonance is clinically relevant when it can identify myocardial fibrosis or clarify anatomy in a patient with complex ventricular arrhythmias. jacc+1jaccUnlocking the Mysteries of Arrhythmic Mitral Valve Prolapse by CMR ...AHA JournalsMitral Valve Prolapse Induces Regionalized Myocardial Fibrosis

Complex ectopy or sustained ventricular arrhythmia requires evaluation for competing structural, ischemic, inherited, and electrical causes before attributing the rhythm disorder to MVP. The absence of another well-defined arrhythmic substrate is part of the reported arrhythmic-MVP construct. cdn clinicaltrialscdn clinicaltrialsProtocol

For MVP without significant MR or adverse chamber findings, the clinically useful surveillance target is interval change in MR severity, LV size and function, LA size, pulmonary pressure, symptoms, and rhythm. Repeat comprehensive echocardiography when symptoms change, a murmur changes, atrial fibrillation develops, or prior imaging shows progressive MR or remodeling; severe MR requires closer reassessment because intervention thresholds are defined by LV and clinical consequences. Nature+1NatureLeft atrial size predicts outcome in severe but asymptomatic mitral regurgitation | Scientific Reportsjacc2020 Focused Update of the 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation: A Report of the American College of Cardiology Solution Set Oversight Committee

In suspected arrhythmic MVP, surveillance should include serial echocardiography and ambulatory rhythm assessment rather than MR-focused follow-up alone. Escalate promptly for new syncope, increasing palpitations, complex ectopy, or sustained ventricular arrhythmia. jacc+1jaccArrhythmogenic Mitral Valve Prolapse: Looking Beyond ... - JACCcdn clinicaltrialsProtocol

MVP alone is not an indication for antithrombotic therapy for primary stroke prevention. Antiplatelet therapy described for secondary prevention after ischemic stroke or TIA is not a substitute for determining the actual embolic mechanism or for managing atrial fibrillation according to its separate indication. ScienceDirectScienceDirectMitral Valve Prolapse - an overview | ScienceDirect Topics