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Question:
How is mitral valve prolapse best managed?
I have been diagnosed with a prolapse valve and a leaking mitral valve. The cardiologist doesn't think anything should be done. The problem is I'm having some pain that lasts up to a few minutes a day which is usually at night, and not when I do activities. I also have some arthritis in feet, knees, wrist joints, etc, so he said the pain is probably skeletal that I feel just underneath my chest on the left hand side. I am aged 50. My father died at 56 a few years after he had his mitral valve replaced as it disintegrated. His heart enlarged and he drowned in his own blood. The cardiologist suggested I come back in 2 years. Is this such a good idea?
submitted by Lois from Australia on 2/24/10
Answer:
by Texas Heart Institute cardiologist, Jose G. Diez, MD
Mitral valve prolapse is a common heart valve abnormality, affecting five to ten percent of the world population. Not all patients have symptoms and not all need treatment. This is one of 4 valves that the heart has (2 in the right side: tricuspid and pulmonic, and 2 on the left side: mitral and aortic). A normal mitral valve consists of two thin leaflets, located between the left atrium (upper chamber) and the left ventricle (lower chamber) of the heart. In patients with mitral valve prolapse, the mitral apparatus (valve leaflets and chordae) becomes affected by a process called myxomatous degeneration. In myxomatous degeneration, the structural protein collagen forms abnormally and causes thickening, enlargement, and redundancy of the leaflets and chordae. When the ventricles contract, the redundant leaflets prolapse (flop backwards) into the left atrium, sometimes allowing leakage of blood through the valve opening (mitral regurgitation). The mitral valve prolapse (MVP) syndrome has a strong hereditary tendency.
Depending on the amount of leakage (regurgitation), patients may develop shortness of breath or an enlarged heart. This severe leakage, may need surgical repair of the valve or to replace it by a prosthetic valve. If there is valve leakage, usually further follow-up is required. The interval for this follow-up (ranging from 6 months to a couple of years)depends on symptoms, the severity of the leakage, enlargement of the heart chambers, function of the left ventricle, pulmonary pressures. Echocardiography (cardiac ultrasound) can measure the severity of prolapse and the degree of mitral regurgitation. Other symptoms may include palpitations, anxiety, atypical chest pain. In order to evaluate this chest pain (so coronary artery disease is not missed) other factors must be considered, such as high blood pressure, high cholesterol, diabetes, overweight, smoking. A stress test may be indicated if there is suspicion of coronary artery disease. The treatment varies depending on symptoms. It may require only observation or to initiate medications (such as a beta-blocker) or surgical repair of the valve.
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Updated February 2010
