Mitral valve prolapse is a condition where the valve between the left atrium and ventricle has malformations, causing a small amount of blood to leak backwards. It is often benign and does not require surgery, but can worsen with age and cause symptoms such as arrhythmia, fatigue, shortness of breath, and chest pain. Treatment options include drugs, minimally invasive balloon valvuloplasty, valve repair or replacement. Mitral valve prolapse can be caused by rheumatic fever, bacterial endocarditis, or be congenital and possibly genetic.
When the heart contracts, the mitral valve, located between the left atrium and ventricle, opens to allow blood to flow into the left ventricle. In mitral valve prolapse, the valve has malformations of the leaflets that open and of the cords, or cords, that support the valve. A small amount of blood leaks backwards, called regurgitation, due to the fact that the flaps don’t meet perfectly when they close.
While once considered a defect, some degree of mitral valve malformation is now thought to be a normal variation. In about 95 percent of cases, benign mitral valve prolapse never requires surgery, although doctors may hear a significant murmur with a stethoscope. Diagnosing mitral valve prolapse, even if it is mild, is important. Even those with a very mild form should probably take antibiotics before dental exams and procedures to prevent bacterial endocarditis.
Mitral valve prolapse isn’t a problem for newborns unless it’s severe or associated with other congenital heart defects, but it tends to get worse with age. Symptoms of this condition may be recognized during adolescence or may not be noticed until a person is in their second or third decade.
Symptoms include arrhythmia, fatigue, shortness of breath and chest pain. Symptoms do not necessarily indicate the severity of the mitral valve prolapse. In some cases, mild prolapse causes symptoms but doesn’t require treatment. In other situations, the prolapse may be significant but not present many symptoms.
When treatment for mitral valve prolapse is needed, several options are considered, the first being drugs to improve heart function and control heart rhythm. If there is a blockage in the valve, minimally invasive balloon valvuloplasty can be tried to open the valve passage and prevent blood from flowing back into the left atria. Balloon valvuloplasty is usually unsuccessful, as mitral valve prolapse tends to recur.
If possible, a cardiothoracic surgeon will try to repair the valve. If necessary, he can separate the flaps and also shorten the strings to create a more effective valve. However, surgeons often choose to replace the valve entirely. The new valve may be a porcine or bovine valve, or often a mechanical valve.
Porcine and bovine valves are not as viable as mechanical valves. They have the advantage of only requiring blood thinners for a few months after surgery. Mechanical valves require lifelong blood thinners, such as warfarin. This can be especially challenging for young children, as warfarin levels need to be monitored constantly.
Mitral valve prolapse has been linked to several causes. Rheumatic fever can damage the mitral valve and surrounding heart tissue. Mitral valve prolapse can be a congenital condition or it can be caused by bacterial endocarditis. There is some evidence to suggest that congenital mitral valve prolapse may be genetic, as it tends to be present in more than one family member. If you have a family history of mitral valve prolapse, let your doctor know, as the problem can easily be diagnosed via echocardiography.
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