Prolapse

Mitral Valve Prolapse

Mitral valve prolapse (MVP)—also known as floppy valve syndrome, Barlow syndrome, redundant cusp syndrome, myxomatous mitral valve syndrome, billowing mitral cusp syndrome, and systolic click-murmur syndrome—is among the most prevalent types of valvular pathologies. It arises from abnormalities in one or more of the following structures: the valve annulus or leaflets, the chordae tendineae, the papillary muscles, and the mitral valve apparatus. Major criteria for this condition include a systolic click and a mid-to-late systolic murmur. Using echocardiography, MVP is diagnosed when either or both mitral valve leaflets are displaced superiorly by greater than 2 mm above the annuli. (Please see Mitral Valve Prolapse under Valve Disease in the Disease Guide for additional discussion about MVP causes, clinical presentation, and pathophysiology.)

Similar criteria are employed when diagnosing MVP with cardiac magnetic resonance imaging. This abnormality is seen optimally on 3-chamber views (F). Gated, balanced steady state free precession (SSFP) sequences—demonstrating excellent contrast throughout the cardiac cycle—are required. Such imaging is especially useful for determining whether the anterior (FB), the posterior (FC), or both leaflets are prolapsed (FA). MVP often occurs with mitral regurgitation, and prolapsed valves may direct regurgitant flow posteriorly (e.g., when the anterior leaflet is prolapsed) or anteriorly (e.g., when the posterior leaflet is prolapsed). Cine imaging is optimal for observing regurgitant jets.