Mitral valve prolapse (MVP) is a condition in which one or both leaflets of the mitral valve (the valve between the left atrium and left ventricle) are enlarged, thickened, or abnormally flexible, causing them to bulge (prolapse) backwards into the left atrium during ventricular contraction instead of closing cleanly. It is also called Barlow’s disease, floppy mitral valve, or myxomatous mitral valve disease.
MVP is the most common heart valve abnormality, affecting approximately 2 to 3% of the general population, and is more prevalent in women. The vast majority of people with MVP have a benign condition that causes no symptoms and requires no treatment beyond reassurance and periodic monitoring. Some experience palpitations or atypical chest pain. However, MVP can be associated with progressive mitral regurgitation as the valve leaflets deteriorate and the supporting chordae tendineae stretch or rupture over time.
MVP is an established, though uncommon, cause of sudden cardiac arrest, particularly in younger women with a specific pattern of bileaflet MVP and certain ECG changes. The mechanism involves ventricular arrhythmias triggered by mechanical stretch of the papillary muscles. This ‘arrhythmic MVP’ subgroup is increasingly recognised and investigated in young survivors of unexplained cardiac arrest.
Management depends on the clinical picture. In asymptomatic patients with mild or no regurgitation, monitoring is all that is required. In those with significant regurgitation, surgical or transcatheter mitral valve repair or replacement may be indicated. Young MVP patients who have survived unexplained cardiac arrest should be investigated for arrhythmic MVP with cardiac MRI and Holter monitoring.
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