Mitral valve prolapse

1. Mitral Valve Prolapse
Superior displacement of 1 or both leaflets into the left atrium

2. Title
1887
• Cuffer and Barbillon described “midsystolic click”
1963
• Barlow and Pocock demonstrated the presence of MR by angiography in patients with
the “click-murmur” syndrome
1966
• Criley JM, Lewis KB coined the term MVP in LV angiogram

3. Epidemiology
• M=F in incidence
• Incidence :2%
• Middle age

4. Diagnosis
Gold standards
• Physical examination
• 2-dimensional (2D) echocardiography

5. Only in parasternal long axis view
• Single leaflet or bi-leaflet prolapse of at least 2 mm beyond the long
axis annular plane, with or without mitral leaflet thickening Prolapse
with thickening of the leaflets >5 mm is called classical

6. Coaptation height
• Coaptation height increases with
MVP(most commonly affected
P2)

7. Carpentier’s
• 3 posterior leaflet scallops-
lateral (P1), middle (P2) &medial
(P3)
• 3 anterior scallops- lateral (A1),
middle(A2) & medial (A3)
• Most of prolapse involve the
posterior middle scallop, which
is easily identified on long-axis
TTE images[110-120 degree]

8. MVP syndrome
Symptom Signs ECG
 Atypical chest
pain
 Exertional
dyspnea
Palpitations
 Syncope
 Anxiety
Low blood
pressure
Thin build
 Repolarization
abnormalities

9. Gene map locus
• 16p12.1-p11.2
• 11p15.4
• 13.q31.3-q32.1
• Xq28

10. Clinical Classification
primary or nonsyndromic Secondary or syndromic
 Marfan syndrome (MFS)
 Loeys-dietz syndrome
 Ehlers-danlos syndrome
 Osteogenesis imperfect
 Pseudoxanthoma elasticum
 Aneurysmsosteoarthritis
syndrome
 HCM

11. Conclusion
1. Fibromyxomatous changes
2. 2% to 3% of the general population
3. Most common valvular pathology requiring surgery
4. Autosomal-dominant nonsyndromic MVP/ rare X-linked
5. Excessive TGF-β signaling
6. Angiotensin I receptor blockade in limiting MVP

12. Analogy
• Senescence is for all like MVP is
equal in incidence for male and
female