[Changing views on mitral valve prolapse]

Abstract

Views regarding mitral valve prolapse, in particular its diagnosis and prognosis, have undergone great changes in recent years. The typical auscultation finding of a meso-systolic click and/or late systolic murmur is very specific for prolapse but it is not very sensitive. The basic diagnostic method of mitral valve prolapse is echocardiography. The non-realistic high prevalence of echocardiographic findings of prolapse in otherwise healthy subjects led recently to the introduction of stricter echocardiographic diagnostic criteria. The term mitral valve prolapse syndrome describes not confirmed association of anatomical valvular prolapse with non-specific symptoms of autonomous dysfunction. An attempt to explain non-specific complaints by an anatomical abnormality of the mitral valve has become very popular but, as increasingly apparent, is purely speculative. Controlled investigations provide evidence that the mitral valve prolapse syndrome does not exist that it is only an incidental coincidence of two conditions very frequently encountered in the population. The prognosis of the great majority of people with a mitral valve prolapse is very favourable. Only about 2-4% of subjects with prolapse are seriously threatened by complications such as infectious endocarditis, thromboembolic episodes, complex arrhythmias and sudden death. This small sub-group with a high risk is formed above all by patients with mitral insufficiency with severe haemodynamic impact. Independent negative prognostic signs are age above 50 years and male sex.