Mitral valve prolapse

Mitral valve prolapse means that the valve leaflets:

  • become thicker and lose elasticity,
  • remain arched to the left atrium,
  • do not close correctly and thus the blood pumped into the left ventricle flows back into the atrium.

The heart consists of four cardiac spaces: two upper atria (atrium) two underlying chambers (ventricles).
The left side of the heart is formed by an ventricle and an atrium connected by a heart valve called the mitral or bicuspid valve.
The mitral valve is a structure with two sails that act as a barrier against the backflow of blood.

The main function of this valve is to open and close the path for the oxygenated blood.
The heart valve:

  1. closes when the left ventricle contracts,
  2. opens when the left ventricle relaxes.

In this way, the return flow of blood from the ventricle to the left atrium is prevented.
A very small amount of reflux (mitral regurgitation) is physiological or normal, but if a certain level is exceeded, it can lead to serious symptoms.

The sails of the heart valve are connected to the inner wall of the ventricle by some tendon threads called chordae tendineae.

Mitral valve prolapse (MCP) usually involves the following changes:

  1. the valve leaflets are longer and larger than normal,
  2. the outer ring is dilated,
  3. the chordae tendineae are too long.

These disorders are scientifically referred to as myxomatous degeneration.
Myxomatous degeneration leads to changes in the connective tissue of the valve, resulting in swelling and thickening of the valve leaflets. Usually the aft sail is the most changed.
Due to this expansion, the sails bulge backwards when closing the flap or lead to a prolapse into the atrium (they move to the opposite side).
A small amount of blood can flow back from the ventricle into the atrium.
The loss of a small amount of blood is not yet a serious problem, but the heart still works well. But if this phenomenon increases significantly, it can lead to complications.

Statistics show that women suffer from mitral valve prolapse more often than men. Women are mainly affected between the ages of 20 and 40.


Types of mitral valve prolapse

  • A mild form of mitral valve prolapse is characterized by the bulging of the valve leaflets and is called “billowing”; at this stage, the regurgitation of blood is low.
    Most patients do not even know that they have this disorder.
  • Moderate mitral valve prolapse is characterized by an intermediate expulsion of blood, the tendon threads are diluted and lengthened (floppy valve).
  • Over time, some of the tendon threads can stretch excessively, until they are completely torn off. This situation is called “flail”.
    This is a serious prolapse because the valve sail turns backwards and the regurgitation of the blood becomes dangerous.

Causes of mitral valve prolapse

  • The main cause is myxomatous degeneration, which leads to thickening of the heart valve.
  • Most doctors believe that mitral valve prolapse is congenital and a hereditary (genetic) predisposition.
    In fact, it is present in 7% of children.
    This disease affects 2% to 6% of the entire population.
  • Mitral valve prolapse can occur along with other genetic conditions, such as:
    • Marfan syndrome (connective tissue disease) – People who suffer from this disorder are tall, lean, have long arms and legs, and also have an abnormality of the skeleton, such as hyperkyphosis (round back) and scoliosis.
      In this syndrome, the hands and limbs are longer than normal.
      People with Marfan syndrome have extremely flexible joints and may have an abdominal aortic aneurysm.
    • Ehlers-Danlos syndrome,
    • Osteogenesis imperfecta, etc.
  • Heart attack (myocardial infarction) – can damage the holding structures of the valve.
  • Another cause related to mitral valve prolapse is a disease of the autonomic nervous system, that is, the system that controls vital functions such as breathing.
    In the medical term one speaks of dystonia.

Symptoms of mitral valve prolapse

In many cases, this disease is asymptomatic (without symptoms).

The following symptoms are possible:

  • Fatigue
  • Migraine
  • Anxiety and panic attacks
  • Chest pain
  • Shortness of breath (dyspnea)
  • Pulmonary edema (only in acute mitral insufficiency)
  • Accelerated heartbeat and palpitations
  • Arrhythmia or irregular heartbeat, for example, extrasystoles. The conduction of the electrical signal that causes the contraction of the atrium must pass through a healthy muscle. If the left atrium is dilated due to mitral valve prolapse, fibrous areas form that influence the transmission of the electrical stimulus. The result is extrasystoles.

Complications of mitral valve prolapse

Complications include:

  • Endocarditis – inflammation of the inner lining of the heart (endocardium) lining the heart and cardiac cavities, resulting in inflexibility and fibrosis of the valves.
  • Decompensated heart failure – In a healthy person, the heart pumps about 5-6 liters of blood per minute. If some of the blood flows back into the left atrium, the heart has to pump much more, up to 10-15 liters per minute.
    As a result, the left ventricle is dilated (decompensation) and cell elasticity is lost.
  • Stroke – Mitral valve prolapse can lead to the formation of an embolus that can reach the brain.
  • In rare cases (< 1%) there is a risk of sudden death, but the patient usually has other symptoms, such as cardiac arrhythmias.

Diagnosis of mitral valve prolapse

The doctor suspects mitral valve prolapse after performing a physical exam with an auscultation via the stethoscope.
The doctor may hear a strange noise, which is also called a heart murmur and is a turbulence of the blood in the heart.
The abnormal movement of the mitral valve can produce a deviant sound called a “click.”
If the patient has mitral regurgitation, the doctor can hear the sound of the heart caused by the reflux of the blood.

An echocardiogram, i.e. an echography of the heart, is used to diagnose mitral valve prolapse.

The doctor can track the abnormal movement of the heart valve on a monitor and thus determine the degree of prolapse.
Mitral regurgitation can be seen in a color Doppler sonography.

An electrocardiogram is not sufficient for diagnosis, as it may appear normal in a person with severe mitral regurgitation.

Treatment of mitral valve prolapse

In most cases of mitral valve prolapse, no therapy is required because there are no symptoms and the disease is not so severe that it requires medical treatment.

It all depends on the severity of symptoms and complications, such as:

  • regurgitation of blood,
  • Arrhythmia.

People with symptomatic mitral valve prolapse must undergo regular check-ups.

Symptoms may include shortness of breath and difficulty climbing stairs, which was not the case a few months ago.

Doctors must prevent the following diseases:

  • Arrhythmia
  • Endocarditis
  • stroke,
  • Thromboembolism
  • Pulmonary edema.

These complications can arise in more severe cases.
Treatment of mitral valve prolapse consists of pharmacological therapy, surgery, or both.

  • If the patient has a mild mitral valve prolapse and does not feel any symptoms, he can continue his normal daily activities and do the sports he prefers, for example, bodybuilding, running or swimming.
  • With severe prolapse with tendon tear, the patient feels severe symptoms and there is a high risk of complications; therefore, he must be admitted to hospital immediately.

Drug therapy for mitral valve prolapse

The medicines used to treat mitral valve prolapse are used to alleviate:

  • chest pain,
  • Regurgitation
  • Arrhythmia.

The doctor may prescribe the following means:

  1. Vasodilators – they help to dilate blood vessels and reduce cardiac work.
  2. Beta-blockers – they are used to treat arrhythmia and reduce an accelerated heartbeat (tachycardia).
  3. Anticoagulants – help prevent blood clots that can form when a person has atrial fibrillation.
  4. Diuretics – taken to reduce fluid accumulation in the lungs.
  5. Antibiotics – to prevent bacterial endocarditis.


The operation is performed to correct or replace the mitral valve.

As a rule, the mitral valve is repaired and the aortic valve is replaced.

Mitral valve correction – doctors maintain the mitral valve in the body and make changes to it that prevent blood regurgitation. The doctor may perform an anuloplasty of the mitral valve to adjust the outer ring of the heart valve.

Testimonial of a patient

I had a mitral valve prolapse and a heart murmur caused by the mitral valve and also the aortic valve for about 25 years.
I had surgery on the mitral valve, a new ring was inserted, a kind of reinforcement.
Before the operation, the following examinations were carried out:

  1. Angio-CT with contrast agent for the evaluation of the coronary arteries
  2. Transesophageal echocardiography

The procedure was performed under general anesthesia and extracorporeal circulation, i.e. the cardiovascular system was connected to a heart-lung machine.
In this way, the heart can be switched off.

My sternum was not opened, but two incisions were made in the rib region. The surgeon preferred this type of access to the heart because there were many calcium deposits around the aortic valve.
He penetrated intercostally, I was brought into a backward curved position.

I had already been operated on 15 years ago for replacement of the aortic valve.
The mitral valve is different from the aortic valve, you continue as long as you can because it is less serious.
When the heart pumps too much, it gets tired. I had surgery when I started wheezing (dyspnea).

The procedure lasted 3 hours.
I still remember how cold the room was.

After surgery and convalescence
When I woke up, I was intubated, a bad experience, but I had already gone through it and tried to calm down.
I could have howled.
Then I was thirsty, but I couldn’t drink.

The hospital stay lasted 7 days, plus 7 days in a rehabilitation clinic.
There, exercises for cardiac rehabilitation were performed.

When I was released, I didn’t feel like doing anything and felt very weak. It was a difficult time.

Now I have the problem that my heart beats very frequently; the cardiologist recommended that I practice a sport at 120 beats per minute, such as riding a bicycle.
Before the procedure, I was not allowed to strain my heart.
The problem now is that I feel very bad when I reach 120 beats per minute, even though the doctor tells me to speed up the heartbeat to 150.
Six months after the operation, I no longer need to carry out checks, only the blood pressure must be monitored.

Mitral valve replacement – Mitral valve replacement occurs when it cannot be reconstructed.
In these cases, the original flap is replaced by an artificial flap.

The artificial flap can be a mechanical flap or a flap constructed of fabric.

  1. The mechanical heart valve has a long lifespan, but anticoagulants must be taken to prevent the formation of blood clots, which can lead to a stroke.
  2. The replacement with a tissue valve allows the elimination of anticoagulants, but it must be replaced again after a certain time.

Doctors prescribe antibiotics to patients before dental procedures or other operations to avoid endocarditis.

Mitral valve prolapse and pregnancy

A woman who wishes to have children who has to undergo surgery must carefully consider the various surgical options together with the heart surgeon.
If replaced by a mechanical heart valve, the patient must take anticoagulants for life.
In pregnancy, this can have consequences:

  • Malformation of the fetus in the first 3 months of pregnancy
  • Increased risk of bleeding in the last trimester of pregnancy and at birth

Pregnant women with low mitral valve prolapse are not at risk of complications, however, doctors may prescribe antibiotics for an infection that could affect the mitral valve.

Diet and lifestyle in mitral valve prolapse

According to the blood group diet, patients with mitral valve prolapse should avoid cereals containing gluten, as this can damage the heart valves; furthermore, limescale deposits may be caused by the calcium contained in milk and dairy products.

It is recommended:

  • limit caffeine and alcohol consumption;
  • control body weight: excess weight puts a strain on the heart;
  • regular exercise;
  • refrain from activities and sports that increase pressure in the chest (diving, weight lifting);
  • quitting smoking to improve overall heart health.

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