Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 10-13: Mitral Valve Prolapse Syndrome + Key Features Download Section PDF Listen +++ ++ 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 (up to 10%) Often only one cusp of the mitral valve prolapses (most commonly the middle cusp of the posterior leaflet) When multiple cusps of both leaflets prolapse, the valve anatomy is often called Barlow disease In occasional patients, MVP is not benign + Clinical Findings Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ Beta-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 not recommended for most situations