Mitral Valve Prolapse
Mitral valve prolapse is characterized by the prolapse of one or both sides of the valve into the atrium (over 2 mm) during the meso-systole.
In primary forms, most commonly in young women, there is a Myxomatous degeneration of the valve, the ring and chordae, which allows penetration of mitral valve in the left atrium during ventricular systole (most commonly involved valve is posterior).
During valvular prolapse are produced traction on the support systems and papillary muscles, respectively with the alteration of the ventricular wall contractility.
Causes of mitral valve prolapse
Most often the cause is idiopathic, familial. Mitral valve prolapse is transmitted either as an autosomal dominant disorder with variable penetrance or may be associated with connective tissue disease.
Mitral valve prolapse can be accompanied with the following conditions:
Acute rheumatic fever;
Coronary disease (papillary muscle dysfunction);
Atrial septal defect (secondary type);
Mitral valve plasty;
Ventricular tachyarrhythmias (Wolff Parkinson White syndrome and long QT syndrome).
Symptoms of mitral valve prolapse
Most patients are asymptomatic.
Symptomatic patients usually have atypical clinical presentations and complex symptoms:
Decreased ability to exercise;
Difficulties in exercise;
Feeling of weakness;
Chest pain, rare with angina character;
Rarely appear syncope through ventricular arrhythmias and even transient ischemic attacks.
The most important listening signs are at the click of meso- systolic and the murmur of meso-systolic and is finalized to the noise II. These changes are accentuated in the upright position.
Orthostatism and the inhale decreasing the left ventricle volume, moving the click earlier, lengthening the breath, and exhale while supine, increasing the volume of the left ventricle, leading to shortness of breath and late appearance of the click.
After stabilizing a diagnosis, must consult a cardiologist that is specialized in heart diseases. It will monitor the disease both clinically and biologically, and will decide depending on the severity of valvulopathy if surgery is necessary in order to replace the valve.
Echocardiography is the method of choice for accurate diagnosis in mitral valve prolapse. Echocardiography reveals posterior displacement of the posterior mitral leaf (sometimes earlier) during late contraction (systole).
Doppler is a very sensitive even for small forms of mitral regurgitation.
ECG is usually normal in asymptomatic patients with mitral valve prolapse.
Chest radiography is not modified in pure mitral valve prolapse.
Skeletal abnormalities may be seen on the trunk: back flat, excavatum pectus (chest excavated), and scoliosis.
Potential complications should not be dramatized. Usually it is better for the patient to be calm.
The most important complication of mitral valve prolapse is severe mitral regurgitation, leading to the left ventricle failure. Reconstructive methods are usually possible; a replacement valve is required only in exceptional cases.
Ventricular arrhythmias – frequent ventricular extra-systoles;
Infective endocarditis, especially in patients with mitral systolic murmur currently in focus. In these patients, antibiotic prophylaxis is indicated before any surgery or dental care.
Sudden death is rare, usually malignant arrhythmias such as ventricular tachycardia;
Cerebrovascular embolic events from platelet fibrin deposits valve, usually young patients with transient ischemic attack, amaurosis fugax, stroke.
Treatment of mitral valve prolapse
Asymptomatic patients do not require treatment. In the presence of breath, infectious endocarditis prophylaxis is indicated before performing surgery or dental extractions.
Correction or mitral valve replacement surgery is indicated in patients with severe mitral regurgitation.
For patients with a history of embolism, in the presence of atrial fibrillation anticoagulation is indicated.