Floppy mitral valve, mitral valve prolapse, and mitral valvular regurgitation
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
It is well recognized that the floppy mitral valve (FMV) complex is the central issue in the FMV, mitral valve prolapse (MVP), and mitral valvular regurgitation (MVR) story. MVP associated with the FMV results from the systolic movement of portions or segments of the FMV complex into the left atrium (LA). Prolapse of the FMV results in unique forms of mitral valvular dysfunction and MVR. When the FMV is recognized as the basic point of reference, diagnostic and nosologic characterizations are simplified. Each of the consequences of FMV dysfunction—MVP, MVR, and FMV surface phenomena—are dynamic entities and contribute to the symptoms and clinical course in this patient population.
Although MVP may occur in the absence of a FMV in individuals with small left ventricular (LV) volume, hyperdynamic, or hypercontractile LV, we do not consider this phenomenon as part of FMV/MVP/MVR.
The natural history of the FMV/MVP/MVR is long, and understanding the life history requires long-term follow-up with serial evaluations.
Identification of those individuals with FMV/MVP whose symptoms are related to, or associated with, autonomic nervous system dysfunction (ie, the FMV/MVP syndrome) is important, as this distinction has diagnostic and therapeutic implications.
In general, patients with FMV/MVP should receive antibiotic prophylaxis for infective endocarditis.
Data suggest that therapy with angiotensin-converting enzyme inhibitors for FMV/MVP and significant MVR may slow the natural regression of the disease.
Surgical therapy should be considered in patients with significant MVR and symptoms related to MVR.
Explanation for the nature of these symptoms, reassurance, avoidance of volume depletion, catecholamines or other cycle-AMP stimulants and a regular exercise program constitute the basic principles of management for patients with FMV/MVP syndrome.
- Boudoulas H, Wooley CF: Mitral Valve: Floppy Mitral Valve, Mitral Valve Prolapse, Mitral Valvular Regurgitation.edn 2, revised. Armonk, NY: Futura Publishing; 2000. Recent book that covers the entire spectrum of FMV/MVP.
- Wooley CF, Sparks EA, Boudoulas H: The floppy mitral valve-mitral valve prolapse-mitral valvular regurgitation triad. Am Coll Cardiol Curr J Rev 1994, 3:25–26.
- Boudoulas H, Schaal SF, Wooley CF: Floppy mitral valve/mitral valve prolapse: cardiac arrhythmias. In Cardiac Arrhythmias, Pacing, and Electrophysiology. Edited by Vardas PE: Boston: Kluwer Academic Publisher; 1998:89–95.
- Edwards JE: Mitral insufficiency resulting from “overshooting” of leaflets. Circulation 1971, 43:606–612.
- Boudoulas H, Toutouzas PK, Wooley CF: Functional Abnormalities of the Aorta. Armonk: Futura Publishing;1996.
- Boudoulas H, Boudoulas D, Sparks EA, et al.: Left atrial performance indices in chronic mitral valve disease. J Heart Valve Dis 1995, 4(suppl 2):S242–247.
- Boudoulas H, Kolibash AJ, Baker P, et al.: Mitral valve prolapse and the mitral valve prolapse syndrome: a diagnostic classification and pathogenesis of symptoms. Am Heart J 1989, 118:796–818. CrossRef
- Davies MJ, Moore BP, Brainbridge MV: The floppy mitral valve: study of incidence, pathology, and complications in surgical, necropsy and forensic material. Br Heart J 1978, 40:468–481.
- Disse S, Abergel E, Houd AM, et al.: Mapping of the first locus for autosomal dominant myxomatous mitral valve prolapse to chromosome 16p11.2-p12.1. Am J Hum Genet 1999, 65:1242–1251. CrossRef
- Devereux RB, Brown WT, Lutas EM, et al.: Association of mitral valve prolapse with low bodyweight and low blood pressure. Lancet 1982, 9:792–795. CrossRef
- Barlow JB, Pocock WA, Marchand P, et al.: The significance of late systolic murmurs. Am Heart J 1963, 66:443–452. CrossRef
- Malkowski MT, Boudoulas H, Wooley CF, et al.: The spectrum of structural abnormalities in the floppy mitral valve: echocardiographic evaluation. Am Heart J 1996, 132:145–151. Describes structural abnormalities in patients with FMV/MVP. CrossRef
- Boudoulas H, Kolibash AJ, Wooley CF: Mitral valve prolapse: a heterogeneous disorder. Primary Cardiol 1991, 17:29–43.
- Nishimura RA, McGoon MD, Shub C, et al.: Echocardiographically documented mitral valve prolapse: long-term follow-up of 237 patients. N Engl J Med 1985, 313:1305–1309. CrossRef
- Freed LA, Levy D, Levine RA, et al.: Prevalence and clinical outcome of mitral valve prolapse. N Engl J Med 1999, 341:1–7. CrossRef
- Dajani AS, Taubert KA, Wilson W, et al.: Prevention of bacterial endocarditis: recommendations by the American Heart Association. JAMA 1997, 277:1794–1801. This fundamental article provides guidelines for prophylaxis of infective endocarditis. CrossRef
- Host U, Kelbaek H, Hildebrandt P, et al.: Effect of ramipril on mitral regurgitation secondary to mitral valve prolapse. Am J Cardiol 1997, 80:655–658. CrossRef
- Cohn LH, Couper GS, Aranki SF, et al.: Long-term results of mitral valve reconstruction for regurgitation of the myxomatous mitral valve. J Thorac Cardiovasc Surg 1994, 107:143–150. Article dealing with surgical reconstruction of the mitral valve in patients with FMV/MVP.
- Boudoulas H, Reynolds JC, Mazzaferri E, et al.: Metabolic studies in mitral valve prolapse syndrome. Circulation 1980, 61:1200–1205.
- Gaffney FA, Bastian BC, Lane LB, et al.: Abnormal cardiovascular regulation in the mitral valve prolapse syndrome. Am J Cardiol 1983, 52:316–320. CrossRef
- Boudoulas H, Wooley CF: The floppy mitral valve, mitral valve prolapse, mitral valvular regurgitation.In Moss and Adams’ Heart Disease in Infants, Children and Adolescents. edn 6. Edited by Moss AJ, Adams FH. Philadelphia: Lippincott, Williams, and Wilkins; 2000.
- Floppy mitral valve, mitral valve prolapse, and mitral valvular regurgitation
Current Treatment Options in Cardiovascular Medicine
Volume 3, Issue 1 , pp 15-24
- Cover Date
- Print ISSN
- Online ISSN
- Current Medicine Group
- Additional Links