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Key Features

  • Usually asymptomatic

  • When symptoms are present, they include

    • Nonspecific chest pain

    • Dyspnea

    • Fatigue

    • Palpitations

  • Most patients are young, female, thin, and some have minor chest wall deformities

  • The significance of mitral valve prolapse (MVP) has been disputed because it is diagnosed by echocardiography frequently in healthy young women (< 10%)

  • In occasional patients, MVP is not benign

Clinical Findings

  • One or more characteristic midsystolic clicks often—but not always—followed by a late systolic murmur

  • Findings are accentuated in the standing position or during the Valsalva maneuver

  • A single midsystolic click is usually benign

  • The late or pansystolic murmur may presage significant mitral regurgitation, often resulting from rupture of chordae tendineae

Diagnosis

  • The diagnosis is primarily clinical and confirmed by Doppler echocardiography

  • Evidence of a dilated aorta on chest radiograph should prompt either CT or MRI angiography

  • If palpitations are an issue, an ambulatory monitor is often helpful to distinguish atrial from ventricular tachyarrhythmias

Treatment

  • β-Blockers in low doses

    • Used to treat the hyperadrenergic state when present

    • Usually satisfactorily treat arrhythmias

  • Selective serotonin reuptake inhibitors have been used, especially if anxiety or orthostatic hypotension is associated, but results have been mixed

  • Aspirin was advocated in the past due to concern regarding systemic emboli, but has been abandoned unless there is evidence for atrial tachyarrhythmias

  • Mitral valve repair is strongly favored over valve replacement

  • The Alfieri procedure

    • Involves stitching the middle of the leaflets together to create a double-orifice mitral valve

    • Can be performed percutaneously (MitraClip)

  • Mitral repair or replacement can be done through a right minithoracotomy

  • Endocarditis prophylaxis is no longer recommended for most situations

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