From the Guidelines
Mitral valve prolapse and mitral regurgitation are distinct heart valve conditions, with prolapse describing the abnormal valve structure and regurgitation describing the functional problem of leaking blood flow. Mitral valve prolapse occurs when the leaflets of the mitral valve bulge or prolapse backward into the left atrium during heart contraction, often due to myxomatous degeneration of the valve tissue 1. In contrast, mitral regurgitation is the backward flow of blood from the left ventricle into the left atrium during heart contraction due to incomplete closure of the mitral valve. While mitral valve prolapse can cause mitral regurgitation, there are many other causes including coronary artery disease, heart attack, rheumatic heart disease, and endocarditis 1.
Some key points to consider:
- Mitral regurgitation can lead to symptoms like fatigue, shortness of breath, and heart failure when severe 1.
- Many people with mitral valve prolapse never develop significant regurgitation, but when they do, treatment may include medications like ACE inhibitors or beta blockers for symptoms, or surgical repair or replacement of the valve in severe cases 1.
- The American and European guidelines consider the same threshold to define LV dysfunction (LVEF <60% and/or LVESD >40 mm) in patients with primary mitral regurgitation (PMR) 1.
- MV surgery is recommended for symptomatic patients with chronic severe primary MR and LVEF >30% 1.
- The key difference between mitral valve prolapse and mitral regurgitation is that prolapse describes the abnormal valve structure, while regurgitation describes the functional problem of leaking blood flow.
It's worth noting that the optimal timing of intervention is not always clear, especially in multivalve disease, and controversy surrounds asymptomatic patients in the absence of haemodynamic impairment 1. However, the preference for MV repair over MV replacement is clearly stated in both American and European guidelines 1.
From the Research
Definition and Causes
- Mitral valve prolapse (MVP) is a condition where the mitral valve leaflets bulge into the left atrium during ventricular systole 2.
- Mitral regurgitation (MR) is a condition where the mitral valve does not close properly, allowing blood to flow back into the left atrium 3.
- MVP is a common cause of MR, and myxomatous degeneration is the most common cause of MVP in the United States and Europe 2.
Symptoms and Complications
- MVP can lead to complications such as MR, endocarditis, sudden cardiac death, and stroke 4, 5.
- MR can cause left-atrial enlargement, left-ventricular overload and dysfunction, and poor outcome when it becomes severe 3.
- Symptoms of MR include shortness of breath, fatigue, and palpitations 3.
Diagnosis and Treatment
- Echocardiography is the method of choice for diagnosing MVP and MR 5, 3.
- Treatment for MVP and MR depends on the severity of the condition and the presence of symptoms 4, 5, 3.
- Valve repair is the treatment of choice for symptomatic MVP and MR, and can improve symptoms and prevent heart failure 3.
- Beta-blockers may have a role in the management of patients with valvular disorders, including MVP and MR 6.
Key Differences
- MVP is a condition where the mitral valve leaflets bulge into the left atrium, while MR is a condition where the mitral valve does not close properly 4, 3.
- MVP can lead to MR, but not all cases of MR are caused by MVP 3.
- Treatment for MVP and MR depends on the severity of the condition and the presence of symptoms, and may include valve repair or replacement, and medical therapy such as beta-blockers 4, 5, 3, 6.