The dynamic mitral valve is prone to three diseases, which are known as mitral stenosis (MS), mitral regurgitation (MR), and mitral valve prolapse (MVP). As a key anatomic and functional structure, advanced disease of this valve may lead to complications such as heart failure and death [1].

MS is commonly caused by rheumatic fever, which is rare in industrialized countries but still prevalent in developing regions. The disease presents in young adults usually in the third or fourth decade with symptoms such as fatigue, palpitations, chest pain, hemoptysis [2]. When MS progresses, the patient may experience dyspnea on exertion, orthopnea, as well as paroxysmal nocturnal dyspnea [3]. Among the clinical features are jugular vein distension and a displaced apical impulse. On auscultation, there is a loud S1 (first heart sound), split S2 (second heart sound), an opening snap, and a diastolic rumble.

MR typically develops as a consequence of aging mechanisms, ischemic disease, rheumatic fever, or prolapse [2] [4]. There are two forms of MR, which are acute (rare) and chronic. Often the result of valvular infection, the presentation of acute MR mimics that of acute heart failure. However, chronic MR evolves gradually and may be asymptomatic in the early stages. Features include fatigue, dyspnea, palpitations, and so forth. Auscultation findings include an apical holosystolic murmur with a soft S1, split S2, and possibly a third heart sound (S3).

MVP is found in up to 3% of the population [5] and is more predominant in young women [2]. While many individuals with prolapse do not exhibit symptoms, some will have fatigue, dizziness, dyspnea, palpitations, chest pain, anxiety, and presyncope. The palpitations may be triggered by emotional stress. The hallmark murmur is a mid-to-late systolic click.

• Heart Disease

  Top Rated Valvular Heart Disease Program The Nancy & Bill Thompson Heart Valve Center is one of a handful of clinics nationwide dedicated to state-of-the-art screening, diagnosis and treatment of valvular heart disease. [hoag.org]

  In other patients with rheumatic heart disease, lesser degrees of MS may accompany mitral regurgitation (MR) and aortic valve disease. [accessmedicine.mhmedical.com]

  The similarity to lesions in carcinoid heart disease and in methysergide-associated valvular disease suggests direct stimulation of myofibroblast growth by serotonin agonist effect. [ncbi.nlm.nih.gov]

  Heart valve disease occurs when one or more of the heart valves do not open or close properly. When it affects more than one heart valve, it is called multiple valvular heart disease. [heartandstroke.ca]

• Mitral Valve Prolapse

  What is mitral valve prolapse (MVP)? Mitral valve prolapse is a condition in which the two valve flaps of the mitral valve do not close smoothly or evenly, but instead bulge (prolapse) upward into the left atrium. [heart.org]

  Mitral Valve Prolapse Mitral valve prolapse ( Figure 2 B) is a common condition, occurring most frequently in women; some types are hereditary. [ahajournals.org]

• Heart Murmur

  The main sign of heart valve disease is an unusual heartbeat sound called a heart murmur. Your doctor can hear a heart murmur with a stethoscope. But many people have heart murmurs without having a problem. [medlineplus.gov]

  If you have a heart murmur, your doctor may recommend that you visit a cardiologist. [mayoclinic.org]

  Mitral valve regurgitation also produces a distinct sound (heart murmur) that a doctor may hear through a stethoscope. To continue reading this article, you must login. [health.harvard.edu]

  Your doctor may listen to your heart with a stethoscope to determine if you have a heart murmur that may indicate a mitral valve condition. [rwjbh.org]

• Late Systolic Murmur

  The syndrome of mid-systolic click accompanying a systolic murmur was first described in the late 1800s, but it was in the early 1960s that its association with mitral regurgitation was demonstrated by Barlow and colleagues using cine-ventriculography [mitralvalverepair.org]

  In the 1960s, Reid7 and Barlow and colleagues1 proposed that mid to late systolic clicks and apical late systolic murmurs were of mitral valvar origin. [heart.bmj.com]

  […] click of the mitral valve and a late systolic murmur Radiology description Echocardiography is the most useful method of diagnosing a prolapsed mitral valve Two and three dimensional echocardiography are particularly valuable as they allow visualization [pathologyoutlines.com]

• Diastolic Murmur

  Loud first heart sound with an opening snap in early diastole. A mid-late diastolic murmur, best heard, with the patient in the left lateral position, with the bell of the stethoscope (see separate Heart Auscultation article). Atrial fibrillation. [patient.info]

  […] diminished and delayed; S 3 or S 4 may be present Murmur softer with Valsalva maneuver Mitral stenosis Diastolic rumble Loud Normal Opening snap may be present Murmur increased with brief exercise Aortic regurgitation Blowing diastolic Soft Normal Wide [aafp.org]

  The indicative low rumbling diastolic murmur is best heard in expiration at the apex, with the bell of the stethoscope. Ongoing elevated pulmonary artery (PA) pressures put strain on the right ventricle, and will eventually cause this to fail. [academic.oup.com]

• Radiculopathy

  Decreased thoracic kyphosis (straight back) is a known cause of hastening back or neck problems, radiculopathy, or even myelopathy. The study aim was to examine the relationship between MMVD, straight back, and the need for cervical fusion. [ncbi.nlm.nih.gov]

• Anuria

  Critical preoperative state is defined as ventricular tachycardia or fibrillation, aborted sudden death or cardiac massage, ventilation prior to surgery, inotropic support, ventricular assist device/balloon pump preoperatively or acute renal failure (anuria [escardio.org]

Individuals with a clinical presentation suggestive of mitral valve disease warrant a thorough workup consisting of the patient and family history, physical exam including auscultation [2], and the appropriate studies.

Laboratory tests

The workup should include a complete blood count (CBC) a complete metabolic panel (CMP).

Imaging

Echocardiography is a critical component of the assessment since it is noninvasive, accessible, and provides information for diagnosis and monitoring of the disease [6]. This modality is sensitive and specific for identifying MS [7] and is the key for diagnosing MR and MVP [8]. This study also allows the clinician to determine the etiology and stage of the valvular abnormality and functionality and size of the atria.

Transthoracic echocardiogram (TTE) reveals mobility, calcification, and thickening of the valve [9]. Moreover, real-time 3-dimensional transesophageal echocardiography (TEE), which is superior to TTE, offers excellent images of the mitral valve [10]. Very importantly, TEE is very beneficial in cases suggestive of endocarditis or presence of thrombi.

Chest radiography is another important investigative study. In patients with MS, a chest X-ray will likely display calcification of the mitral valve, left atrial enlargement, interstitial edema, and prominent pulmonary vasculature. In patients with chronic MR, chest X-ray findings may include left ventricular and left atrial enlargement, and evidence of heart failure such as pulmonary congestion. Similar observations are found in patients with MVP associated with MR.

Other imaging tests such as ventriculography and cardiac magnetic resonance imaging (MRI) may be utilized to measure the regurgitation.

Electrocardiography (EKG)

An EKG is obtained in all patients with cardiac complaints. A typical finding in patients with advanced MS is atrial fibrillation. Other remarkable features include prolonged P wave in lead II, which is indicative of left atrial hypertrophy. Features associated with chronic MR are left ventricular and left atrial hypertrophy, and ST segment changes in lateral leads. Additionally, there are P wave abnormalities in various leads. Occasionally, MVP is associated with benign arrhythmias.

Procedures

Cardiac catheterization is performed selectively prior to surgery. Also, stress EKG is used periodically to monitor MR.

• Hypercapnia

  Pulmonary vascular pressures should be optimized by avoiding hypoxia, hypercapnia, and acidosis to prevent acute right ventricular decompensation. [academic.oup.com]

• P Mitrale

  Electrocardiography[edit] P mitrale is broad, notched P waves in several or many leads with a prominent late negative comp[[mb b [[]]]]onent to the P wave in lead V1, and may be seen in MR, but also in mitral stenosis, and, potentially, any cause of overload [en.wikipedia.org]

  In asymptomatic patients, where the systolic PA pressure is <50 mm Hg, non-cardiac surgery is considered safe.7 ECG AF is common, although p-mitrale may be noted if still in sinus rhythm. [academic.oup.com]

• Prominent V-Waves

  He is in chronic atrial fibrillation (AF), his neck veins are distended with prominent V waves, and he has an enlarged pulsating liver and severe peripheral edema. [onlinejacc.org]

• Prominent A-Wave

  He is in chronic atrial fibrillation (AF), his neck veins are distended with prominent V waves, and he has an enlarged pulsating liver and severe peripheral edema. [onlinejacc.org]

• Left Ventricular Hypertrophy

  However, as mitral regurgitation worsens and the stress on the left ventricle increases, left ventricular hypertrophy develops in order to maintain normal left ventricular pressures. [healio.com]

  For instance, the electrocardiogram (ECG) in long-standing MR may show evidence of left atrial enlargement and left ventricular hypertrophy. Atrial fibrillation may also be noted on the ECG in individuals with chronic mitral regurgitation. [en.wikipedia.org]

• Left Atrial Hypertrophy

  A typical finding in patients with advanced MS is atrial fibrillation. Other remarkable features include prolonged P wave in lead II, which is indicative of left atrial hypertrophy. [symptoma.com]

When this happens, surgery is the best treatment option. However, surgery is too risky for some patients. A newer treatment option, called the MitraClip, was approved by the FDA to treat patients who are high-risk for surgery. [my.clevelandclinic.org]

We will review the etiology, anatomy, pathophysiology, presentation, and treatment of aortic and mitral valve disease. [ncbi.nlm.nih.gov]

Treatment Top 1. Pharmacologic treatment of heart failure. 2. Antithrombotic treatment in patients with atrial fibrillation. 3. Prevention of infective endocarditis and of recurrent rheumatic disease (see Acute Rheumatic Fever ). 4. [empendium.com]

Learn More About Mitral Valve Disease Treatment UPMC Heart and Vascular Institute Mitral Regurgitation Treatment Mitral Stenosis Treatment From our Health Library Mitral Valve Replacement Surgery Mitral Valve Regurgitation Mitral Valve Stenosis Heart [upmc.com]

There are several reasons why left atrial size can have a significantly negative impact on prognosis. [ncbi.nlm.nih.gov]

Prognosis Prognosis for mitral valve regurgitation varies based on its severity. Medication can ease symptoms, but not reverse damage to a valve. Surgical treatments have greatly improved the prognosis for mitral valve regurgitation patients. [baptisthealth.com]

A brief summary of the literature on pulmonary varices associated with mitral valve disease is presented, with special reference to its etiology and surgical treatment. [ncbi.nlm.nih.gov]

Last Updated: April 23, 2015 Last Reviewed: June 22, 2019 Chapter Information Definition, Etiology, Clinical FeaturesTop Mixed mitral valve disease refers to coexisting mitral stenosis (MS) and mitral regurgitation (MR). [empendium.com]

Definition / general Degenerative valve disease occurs due to a pathological weakening / sclerosis of connective tissue Terminology Mitral valve prolapse (MVP), Floppy mitral valve, Flail leaflet, Calcific aortic valve disease Epidemiology Prevalence [pathologyoutlines.com]

PMID 11728952. ^ "Pectus Excavatum: Epidemiology". Medscape. Retrieved 14 April 2016. ^ a b c d e f g h Playford, David; Weyman, Arthur (2001). "Mitral valve prolapse: time for a fresh look". Reviews in Cardiovascular Medicine. 2 (2): 73–81. [en.wikipedia.org]

Epidemiology of valvular heart disease in the adult. Nat Rev Cardiol. 2011;8:162–72. [Most up-to-date report of the epidemiology of vavular heart disease in Europe.] [PubMed] [Google Scholar] 2•. O'Rourke RA, Bailey SR. [ncbi.nlm.nih.gov]

Epidemiology United States data Mitral valve prolapse (MVP) is thought to be inherited with increased expression of the gene in female individuals (2:1). [emedicine.medscape.com]

The aetiology and epidemiology of mitral valve disease have been discussed in recent articles in this series and will not be covered in detail here. [escardio.org]

We will review the etiology, anatomy, pathophysiology, presentation, and treatment of aortic and mitral valve disease. [ncbi.nlm.nih.gov]

LEARNING OBJECTIVES After reading the preceding article and taking this test, you should be able to: Identify pathophysiology associated with aortic and mitral valve disease. List clinical manifestations of aortic and mitral valve disease. [journals.lww.com]

The Current Status is organized into the following six sections: The first section is entitled Fundamentals and describes our understanding of mitral valve disease based on pathophysiological triad and Carpentier's approach of valve analysis using functional [themitralvalve.org]

[…] pathological weakening / sclerosis of connective tissue Terminology Mitral valve prolapse (MVP), Floppy mitral valve, Flail leaflet, Calcific aortic valve disease Epidemiology Prevalence of degenerative valve disease is estimated at 2 - 3% of the population Pathophysiology [pathologyoutlines.com]

To prevent dehiscence, we selected short bands and compared the echocardiographic changes between this method and the Cosgrove ring. METHODS: Three sutures are placed in the commissures using two bands, which shortens the annular length by 60%. [ncbi.nlm.nih.gov]

Today, thanks to improved quality of medical care and increased attention on prevention, people are living longer. [eu.courierpostonline.com]

Problems with the mitral valve may lead to irreversible changes that prevent the heart from pumping properly, which is why experts now recommend early surgery for mitral valve disease to prevent these irreversible changes. [hoag.org]

During the heart’s contraction, the mitral valve closes, preventing blood from flowing back to the left atrium. A diseased mitral valve no longer opens or closes properly. [virginiaheart.com]

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