Mitral Valve Prolapse (MVP)

What mitral valve prolapse is

The mitral valve sits between the left atrium (upper chamber) and the left ventricle (main pumping chamber). It has two leaflets that close tightly when the ventricle contracts, so blood goes forward into the aorta instead of backward.

In MVP, the leaflets are thickened and stretchy. When the ventricle squeezes, part of a leaflet billows back into the atrium like a sail. The supporting cords (chordae tendineae) may be long or thin. If the leaflets no longer meet properly, blood leaks backward. This leak is called mitral regurgitation.

Types

• Barlow's disease: both leaflets are bulky and excessively floppy, usually diagnosed younger.
• Fibroelastic deficiency: thin leaflets with one weak area, often in older adults, with a risk of a cord breaking.
• Bileaflet MVP: both leaflets prolapse, which carries a higher risk of rhythm problems.

Symptoms of mitral valve prolapse

Many people never notice anything. When symptoms occur, they include:

• Palpitations: skipped beats, thumps or a racing heart.
• Chest discomfort that is usually sharp and brief and not related to exertion.
• Fatigue and reduced exercise tolerance.
• Breathlessness, especially if a significant leak develops.
• Lightheadedness.
• Anxiety, which may relate to awareness of palpitations.

Older literature described "MVP syndrome" with anxiety, low blood pressure and fatigue. Studies have since shown these symptoms are not clearly more common in people with MVP than without, but some people do have them together.

If the leak becomes severe, symptoms of heart failure appear: breathlessness on exertion or lying flat, ankle swelling and tiredness.

Causes and risk factors

• Inherited tendency: MVP often runs in families, inherited in an autosomal dominant pattern with variable expression.
• Connective tissue disorders: Marfan syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome and osteogenesis imperfecta.
• Other associations: a thin build, chest wall shape differences (pectus excavatum, straight back), and scoliosis.
• Age-related degeneration in older adults.

Diagnosis

1. Listening to the heart: a mid-systolic click, sometimes followed by a murmur if the valve leaks. The click moves earlier when standing and later when squatting.
2. Echocardiogram: the key test. It confirms prolapse (displacement of more than 2 mm beyond the valve ring), shows which leaflets are involved and measures any leak and the size and function of the heart.
3. Transesophageal echocardiogram (TEE): an ultrasound probe passed into the esophagus gives a clearer view before repair.
4. ECG and Holter monitor: to look for rhythm problems if you have palpitations or fainting.
5. Cardiac MRI: measures leak size precisely and can show scarring of the heart muscle, linked to arrhythmias.

Is mitral valve prolapse serious?

For most people, no. The main concerns are:

Mitral regurgitation

A significant leak develops in a minority, more often in men, people over 50, and those with thickened leaflets. Severe regurgitation strains the heart and can lead to heart failure and atrial fibrillation if not repaired in time. A chordal rupture can cause a sudden severe leak with rapid breathlessness.

Arrhythmic MVP

A small subgroup has frequent or complex extra beats from the ventricles. Rarely, this leads to dangerous rhythms and sudden cardiac death. Warning features include bileaflet prolapse, a separation where the valve attaches to the heart wall (mitral annular disjunction), scarring on MRI, and changes on the ECG. Young women with bileaflet MVP are overrepresented. People with these features are monitored more closely.

Endocarditis

Infection of the valve (endocarditis) is uncommon but more likely if the valve leaks. Routine antibiotics before dental work are no longer recommended for MVP, but good dental hygiene and regular checkups are.

Stroke

The link with stroke is weak in otherwise healthy people. The risk rises mainly if atrial fibrillation develops.

Treatment

No or mild leak

• No treatment is needed. Repeat echocardiograms every 3 to 5 years for mild leaks, more often for moderate ones.
• Stay active; most people can play sports normally.
• Limit caffeine, alcohol and stimulants if palpitations are bothersome.

Medicines

• Beta-blockers can reduce palpitations and chest discomfort.
• Blood thinners for atrial fibrillation or after a stroke.
• Heart failure medicines for symptoms while awaiting valve repair.

Medicines do not stop the valve from leaking.

Valve repair or replacement

Severe regurgitation is usually treated before the heart becomes enlarged or weakened.

• Surgical repair: the preferred option for MVP. The surgeon trims the floppy leaflet, adds artificial cords and places a ring. In experienced centers, repair succeeds in more than 90 percent of degenerative valves and lasts many years. Minimally invasive and robotic approaches are available.
• Transcatheter edge-to-edge repair (TEER): a clip delivered through a vein in the leg grips the leaflets together. It is used for people at high surgical risk.
• Valve replacement: when repair is not possible.

Living with MVP

Most people with MVP live normal, active lives. Pregnancy is usually well tolerated unless there is a severe leak or rhythm problem. Report new symptoms promptly, especially fainting, breathlessness or prolonged palpitations, and attend scheduled echo follow-up.

Frequently asked questions

Is mitral valve prolapse serious?

Usually not. Most people with MVP have no or mild leakage, no symptoms and a normal life expectancy. A minority develop a severe leak needing repair, and a small subgroup has significant heart rhythm problems. Regular checkups with echocardiograms identify those who need treatment.

What are the symptoms of mitral valve prolapse?

Most people have no symptoms. Some notice palpitations or skipped beats, brief chest discomfort, tiredness, lightheadedness or anxiety. Breathlessness and ankle swelling suggest a significant leak and need prompt review. Fainting needs urgent assessment.

What causes mitral valve prolapse?

MVP is mostly caused by an inherited change in the valve tissue, making leaflets thick and stretchy, and it often runs in families. It is more common in connective tissue disorders such as Marfan and Ehlers-Danlos syndromes. In older people, age-related degeneration can cause it.

Can mitral valve prolapse go away?

No. The valve structure does not return to normal. But in most people it stays stable for decades. Some people diagnosed decades ago with older, looser criteria would not be classed as having MVP today. A leak can slowly worsen, which is why follow-up scans are advised.

What is the life expectancy with mitral valve prolapse?

For most people it is normal. Those with severe leakage have a higher risk of heart failure and atrial fibrillation, but timely valve repair restores near-normal life expectancy. The small group with high-risk rhythm features needs specialist follow-up.