Mitral Valve Prolapse

Mitral valve prolapse (Barlow’s disease) is a connective tissue disorder which results in the valve leaflets becoming redundant causing prolapse into the left atrium during systole.

This can lead to mitral valve regurgitation. 

Diagnosis of mitral valve prolapse on echocardiography is done by examing the parasternal long-axis view. If the valve leaflets pass the plane of the annulus, then prolapse is present. See the image to the right.

Mitral valve prolapse is usually asymptomatic unless congestive heart failure occurs from mitral regurgitation. The mitral valve prolapse syndrome can be associated with palpitations, chest pains, and panic attacks. The etiology remains unclear however may be due to activation of the sympathetic nervous system.

Mitral valve prolapse produces a mid-systolic click usually followed by a uniform, high-pitched murmur.  The murmur is actually due to mitral regurgitation that accompanies the MVP, thus it is heard best at the cardiac apex. MVP responds to dynamic auscultation. After sudden standing, preload is decreased and the click moves earlier in systole. With sudden squatting, preload increases and the click moves later in systole.

Mitral valve prolapse is the most common indication for surgical mitral valve repair due to severe mitral valve regurgitation.

The most common segment involved in mitral valve prolapse is termed the P2 segment. The mitral valve structure is complex. The anterior and posterior leaflets have been anatomically separated into 3 segments each (A1, A2, A3 and P1, P2, P3).

By Steven Lome