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Nonarrhythmic complications of mitral valve prolapse

Sorin Pislaru, MD, PhD
Maurice Enriquez-Sarano, MD
Section Editor
Catherine M Otto, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Mitral regurgitation (MR) is the most frequent valve disease in the United States population [1], with mitral valve prolapse (MVP) the most common cause of MR requiring surgical correction [2]. While the diagnosis of MVP is relatively simple (the clinical finding of a systolic click and/or murmur leads to confirmatory echocardiography), the medical literature is somewhat confusing. This is related to the overlap between denomination of MVP clinical syndromes, etiology and mechanisms, and to a change in echocardiographic diagnostic criteria for MVP. (See "Definition and diagnosis of mitral valve prolapse".)

Major nonarrhythmic complications of MVP including MR, heart failure, infective endocarditis, and cerebrovascular accidents will be reviewed here. Other conditions associated with MVP are discussed elsewhere. (See "Mitral valve prolapse syndrome" and "Arrhythmic complications of mitral valve prolapse".)

It has been estimated that the overall risk of serious complications in MVP is about 1 percent per year in patients with clinically and echocardiographically diagnosed disease; this is a not a cumulative risk since some patients have multiple complications [3]. However, patients with MVP can be divided into widely variable risk groups, with the high-risk group having a cardiovascular mortality of 3.4 percent per year [4].

The most important risk factors for mortality are presence of moderate to severe MR and left ventricular ejection fraction less than 50 percent [4]. The severity of MR also correlates with the requirement for valve replacement and the incidence of infective endocarditis, cerebral embolism, and death (figure 1) [4,5]. (See "Natural history of chronic mitral regurgitation caused by mitral valve prolapse and flail mitral leaflet", section on 'Natural history of mitral valve prolapse'.)


Primary mitral valve prolapse (MVP) is the most common etiology of pure mitral regurgitation (MR), accounting for over 50 percent of cases; it also accounts for over 60 percent of patients with ruptured chordae tendineae [6].


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Literature review current through: Sep 2016. | This topic last updated: Sep 4, 2015.
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