What is prolapse and what are the degrees?
The mitral valve consists of two leaflets, which are held in place by thin chordae tendineae. During contraction of the ventricle, the valves close and do not allow blood back into the atrium. If the tissue of the valves is redundant and tensile, and the chords are elongated, the valves bend into the atrium cavity. Previously, prolapse was divided into degrees according to the depth of the deflection in millimeters, but now the main thing is the presence and severity of regurgitation, that is, reverse blood flow. The prognosis and the need for treatment depend on it. In children and adolescents, a slight deflection of the valves is often detected against the background of rapid growth.
- Primary - with myxomatous degeneration of the valves
- Secondary - for heart disease, rheumatism, chord injury
- No or slight regurgitation
- With moderate regurgitation
- With severe regurgitation
- Prolapse in hereditary connective tissue diseases
Causes and risk factors
Primary prolapse is associated with genetically determined changes in the connective tissue of the valve: the valves thicken, become loose and tensile. It often occurs in several family members. Prolapse is more often detected in people of thin build, with increased joint mobility, scoliosis, flat feet - signs of connective tissue dysplasia. It is characteristic of Marfan and Ehlers-Danlos syndromes. Secondary prolapse develops with coronary heart disease with damage to the papillary muscles, cardiomyopathies, after rupture of the chords, and with rheumatic valve damage.
- Hereditary predisposition
- Connective tissue dysplasia
- Marfan syndrome, Ehlers-Danlos syndrome
- Thin build, scoliosis, joint hypermobility
- Coronary heart disease
- Rheumatic valve disease
Symptoms
Most people with MVP do not experience any symptoms. During auscultation, the doctor may hear a characteristic click and noise. Sometimes there is a feeling of interruptions, palpitations, stabbing pain in the heart area not associated with exercise, fatigue, dizziness. These complaints are often explained not by the valve itself, but by the peculiarities of autonomic regulation and anxiety. With severe mitral regurgitation, shortness of breath on exertion, weakness, edema, and attacks of atrial fibrillation appear. Serious complications - infective endocarditis, chord rupture, dangerous ventricular arrhythmias - are rare.
- Most often proceeds without complaints
- Palpitations and feeling of irregularities
- Stitching pain in the chest unrelated to exercise
- Fatigue, dizziness
- Dyspnea with severe regurgitation
- Attacks of irregular heartbeat
Diagnostics
The main diagnostic method is echocardiography. It shows how much the valves bend, whether there is any thickening, evaluates the degree of regurgitation, the size of the left atrium and ventricle, and the pressure in the pulmonary artery. The diagnosis is made according to strict criteria, so a slight displacement of the valves is not always considered prolapse. ECG and Holter monitoring are needed for complaints of irregular heartbeats and palpitations. If regurgitation is significant and surgery is planned, transesophageal echocardiography and sometimes cardiac MRI are performed. The frequency of repeated examinations is determined by the cardiologist depending on the degree of regurgitation.
- Echocardiography
- ECG
- Holter ECG monitoring
- Transesophageal echocardiography according to indications
- Stress tests for complaints
- MRI of the heart in difficult cases
Treatment and lifestyle
Prolapse without significant regurgitation does not require treatment. A healthy lifestyle, regular physical activity, smoking cessation, blood pressure monitoring and periodic echocardiography are recommended. For palpitations and vegetative complaints, normalization of sleep, limiting caffeine and energy drinks help; if necessary, the doctor prescribes drugs that slow down the rhythm. In case of atrial fibrillation, thrombus formation is prevented. Severe mitral regurgitation with cardiac enlargement or symptoms is treated surgically: preference is given to repair of the native valve. Before dental procedures, antibiotics are prescribed only at the discretion of the doctor for special indications.
- Regular monitoring by a cardiologist
- Repeated echocardiography according to the doctor’s schedule
- Moderate physical activity
- Limit caffeine and energy drinks
- Oral hygiene and dental treatment
- Valve repair or replacement for severe regurgitation