Prolonged Left Heart Valve: Risks, Monitoring, and Treatment Options

Left valve elongation

Hello, doctor.
I'm very worried, so I have a lot of questions.
I apologize for bothering you.
I had a chest X-ray due to excessive phlegm, which revealed an enlarged heart.
I then consulted a cardiologist who arranged for an echocardiogram.
After the ultrasound, the doctor informed me that my left valve is significantly longer than normal and advised me to come back for check-ups every 3-5 years to monitor for any deterioration, but did not mention any need for treatment.

Doctor, I would like to ask:
1.
Why is the left heart valve elongated? Can an elongated heart valve lead to serious complications?
2.
Is treatment necessary for an elongated left heart valve?
3.
Why is it necessary to have check-ups every 3-5 years to monitor for deterioration? Is deterioration likely to occur?
4.
Is an elongated left heart valve the same as mitral valve prolapse?
5.
What should I pay attention to regarding the elongated left heart valve?

Tian, 20~29 year old female. Ask Date: 2012/06/29

Dr. He Dongjin reply Cardiology

Hello, relax! This is mitral valve prolapse.
Of course, it won't lead to death; there are no diseases that would cause that without treatment.
You only need to see a doctor every 3 to 5 years, and it rarely worsens.
Doctors always leave a little uncertainty, telling you not to return for follow-ups, which is strange.
In any case, it's not a big deal, so don't worry.
Here’s an article introducing mitral valve prolapse for your reference.
Mitral valve prolapse is the most common condition.
It is a syndrome that can result from abnormalities in one or more structures of the mitral valve, including the leaflets, chordae tendineae, papillary muscles, or valve annulus, and may be associated with mitral regurgitation (backflow).

What causes mitral valve prolapse? Some cases have a genetic predisposition, with a prevalence in females that is twice that of males.
It is more commonly found in first-degree relatives of individuals with mitral valve prolapse, as well as in those who are slender, have congenital scoliosis, pectus excavatum, or pectus carinatum.
Due to changes in the connective tissue of the mitral valve, there is abnormal hyperplasia of the spongy structure's middle layer, causing the mitral valve to appear thickened and elongated, leading to the prolapse phenomenon during closure, hence the term mitral valve prolapse.
How is the diagnosis of mitral valve prolapse confirmed? Clinically, it often presents with non-specific symptoms such as palpitations, chest discomfort, and easy fatigue, and there is often a tendency towards anxiety and nervousness.
The physician's stethoscope is the first diagnostic tool, allowing the detection of typical mid-systolic click sounds and possibly accompanying systolic murmurs.
The definitive diagnostic tool is echocardiography.
Simple mitral valve prolapse must meet the international diagnostic criteria of having a displacement greater than 2 mm above the mitral valve annulus line.
Other changes, such as valve thickening, can also be used to confirm the diagnosis of mitral valve prolapse.

Overdiagnosis should be avoided to prevent unnecessary psychological burden and waste of healthcare resources.

Does mitral valve prolapse require surgery? Some changes in the connective tissue of the mitral valve may extend to the chordae tendineae and valve annulus, leading to chordal rupture and annular dilation or calcification, resulting in moderate to severe mitral regurgitation.
Fortunately, these cases account for only about 10% of all mitral valve prolapse cases.
The management principles and surgical indications for severe mitral valve prolapse and regurgitation are no different from those caused by other factors leading to severe regurgitation.
What are the potential complications of mitral valve prolapse? A small portion may develop thrombotic events due to damage to the endothelial layer of the valve, leading to conditions such as stroke or retinal artery occlusion; some may also experience arrhythmias.
Patients with mitral valve prolapse associated with regurgitation and heart murmurs have a higher risk of developing infective endocarditis.
Sudden cardiac death is associated with severe mitral regurgitation, significant structural abnormalities of the valve, or associated ventricular arrhythmias.
Pharmacological treatment for mitral valve prolapse includes beta-blockers or anxiolytics, which can improve most symptoms, but the valve's structure will not change with medication.
If the patient has arrhythmias or cardiac enlargement due to regurgitation, other antiarrhythmic medications or cardiac drugs may be necessary.
How often should mitral valve prolapse be monitored? If the mitral valve functions normally and the patient has no specific symptoms, due to the good prognosis, it is advisable to maintain a normal lifestyle and have echocardiographic follow-ups every 3 to 5 years.
If there are significant systolic murmurs and mitral regurgitation, prophylactic antibiotics for endocarditis become necessary; these patients should be monitored more frequently, approximately once a year with echocardiography.
In summary, we have gained a deeper understanding of mitral valve prolapse.
Remember, most cases of mitral valve prolapse are benign, usually with a good prognosis, requiring only observation and echocardiographic follow-ups every few years.
If you have any questions, feel free to discuss them with a physician at our cardiology clinic.
Don't let mitral valve prolapse become a psychological burden; you can still enjoy a healthy and active life like everyone else.

Reply Date: 2012/06/29

More Info

Understanding prolonged left heart valve conditions, particularly mitral valve prolapse (MVP), is crucial for managing potential risks and treatment options. Your concerns are valid, and it’s important to clarify these points to help you feel more informed and less anxious about your condition.

1. Why does the left heart valve become elongated?
The elongation of the left heart valve, particularly the mitral valve, can occur due to several factors. Genetic predisposition is a significant contributor; some individuals may have inherited connective tissue disorders, such as Marfan syndrome or Ehlers-Danlos syndrome, which can lead to structural abnormalities in the heart valves. Additionally, age-related changes, rheumatic fever, or degenerative changes can also cause the valve to stretch or elongate.
2. Can an elongated left heart valve lead to severe complications?
While an elongated or prolapsed valve can be concerning, it does not automatically mean that severe complications will occur. Many individuals with mitral valve prolapse live normal, healthy lives without significant issues. However, in some cases, it can lead to mitral regurgitation, where blood leaks backward into the left atrium, potentially causing symptoms like palpitations, fatigue, or shortness of breath. In rare cases, severe regurgitation may require surgical intervention.

3. Why is monitoring every 3-5 years necessary?
Regular monitoring is essential to assess whether the condition is worsening. The mitral valve can change over time, and periodic echocardiograms allow your healthcare provider to evaluate the valve's function and structure. If there are signs of significant regurgitation or other complications, earlier intervention may be necessary. The 3-5 year interval is often sufficient for stable cases, but your doctor may adjust this based on your specific situation.

4. Is an elongated left heart valve the same as mitral valve prolapse?
Yes, an elongated left heart valve often refers to mitral valve prolapse. In this condition, the valve leaflets bulge (prolapse) into the left atrium during contraction of the heart. This can be due to the elongation of the valve leaflets or the chordae tendineae (the cords that connect the valve to the heart muscle). While MVP is common and often benign, it can sometimes lead to complications, as mentioned earlier.

5. What should you pay attention to regarding the left heart valve?
It’s important to monitor for any new symptoms that may arise, such as:
- Palpitations or irregular heartbeats
- Shortness of breath, especially during exertion
- Fatigue or decreased exercise tolerance
- Swelling in the legs or feet
If you experience any of these symptoms, you should contact your healthcare provider promptly. Additionally, maintaining a healthy lifestyle, including regular exercise, a balanced diet, and avoiding excessive caffeine or stimulants, can be beneficial.

In conclusion, while the diagnosis of an elongated left heart valve can be concerning, it is often manageable with regular monitoring and a healthy lifestyle. Your healthcare provider will guide you on the appropriate follow-up and any necessary interventions based on your specific condition. It’s always a good idea to discuss your concerns and questions with your doctor, as they can provide personalized advice and reassurance based on your health status.

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