Left Valve Prolapse and Regurgitation: Key Insights

Cardiac issues

Is a long left valve the same as left valve insufficiency? During the echocardiogram, the doctor mentioned that your left valve is much longer than average.
The doctor only said this and did not provide further information.
What should I do about the significantly long left valve? What should I pay attention to? Is treatment necessary?

Shi, 20~29 year old female. Ask Date: 2012/06/30

Dr. He Dongjin reply Cardiology

Hello, relax.
This is just 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, as it rarely worsens.
Doctors often leave a little uncertainty, suggesting you don’t need to return for follow-ups, which is odd.
In short, 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 be caused by abnormalities in one or more structures of the mitral valve, including the leaflets, chordae tendineae, papillary muscles, or the valve annulus, and may be accompanied by 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, the middle layer of the spongy structure of the valve becomes abnormally 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 possible accompanying systolic murmurs.
The definitive diagnostic tool is echocardiography.
Simple mitral valve prolapse must have a degree of prolapse greater than 2 mm above the mitral valve annulus line to meet international diagnostic criteria.
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 medical expenses.

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 with regurgitation are no different from those caused by other reasons leading to severe regurgitation.

What are the potential complications of mitral valve prolapse? A small number may experience thromboembolic events due to damage to the endothelial layer of the valve surface, leading to conditions such as stroke or retinal artery occlusion; a few may also have arrhythmias.
Patients with mitral valve prolapse accompanied by 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 the combination of anxiolytic medications, which can improve most symptoms, but the structure of the valve 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 function is normal and the patient has no specific symptoms, due to the good prognosis, it is advisable to maintain a normal lifestyle and have echocardiography every 3 to 5 years.
If there is significant systolic murmur and mitral regurgitation, prophylactic antibiotics for endocarditis become necessary; this group of patients must 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 are benign and usually have a good prognosis, requiring only observation and echocardiographic follow-up 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 anyone else.

Reply Date: 2012/06/30

More Info

Left valve prolapse and regurgitation are related but distinct conditions that can affect the heart's function. Understanding these conditions is crucial for managing heart health effectively.

Left Valve Prolapse: This condition occurs when the left atrioventricular valve, commonly known as the mitral valve, does not close properly. In mitral valve prolapse (MVP), the valve leaflets are elongated or floppy, causing them to bulge back into the left atrium during the heart's contraction. This can lead to mitral regurgitation, where blood leaks backward into the atrium instead of flowing forward into the left ventricle.

Mitral Regurgitation: This is a condition that can arise from mitral valve prolapse. It refers to the backward flow of blood due to the improper closure of the mitral valve. The severity of mitral regurgitation can vary, and it may be classified as mild, moderate, or severe based on the amount of blood that leaks back into the atrium. Symptoms may include fatigue, shortness of breath, and palpitations, especially during exertion.

Are Left Valve Prolapse and Regurgitation the Same?: While they are related, they are not the same. MVP can lead to mitral regurgitation, but not all cases of MVP result in significant regurgitation. Some individuals with MVP may have no symptoms and may not require treatment, while others may experience complications that necessitate medical intervention.

What Should You Do If Your Doctor Says Your Valve Is Longer Than Normal?: If your doctor has indicated that your mitral valve is longer than average, it is essential to follow up with them for further evaluation. Here are some steps to consider:
1. Regular Monitoring: Your doctor may recommend regular echocardiograms to monitor the valve's function and any potential regurgitation. This is particularly important if you have symptoms or if the prolapse is significant.

2. Symptom Awareness: Be vigilant about any symptoms that may arise, such as shortness of breath, fatigue, or palpitations. If you experience any of these symptoms, report them to your healthcare provider promptly.

3. Lifestyle Modifications: Maintaining a heart-healthy lifestyle can be beneficial. This includes regular exercise, a balanced diet low in saturated fats and high in fruits and vegetables, and avoiding smoking and excessive alcohol consumption.

4. Medication: In some cases, if mitral regurgitation is significant, your doctor may prescribe medications to help manage symptoms or reduce the workload on your heart.

5. Surgical Options: If the regurgitation becomes severe and symptoms are present, surgical options may be considered. This could involve repairing or replacing the mitral valve.

6. Consultation with a Specialist: If you have concerns or if your condition is complex, consider seeking a referral to a cardiologist who specializes in valve disorders. They can provide a more in-depth evaluation and tailored management plan.

In summary, while left valve prolapse and regurgitation are interconnected, they are not synonymous. If your doctor has noted that your valve is longer than normal, it is crucial to engage in ongoing monitoring and maintain open communication with your healthcare provider to ensure optimal management of your heart health. Regular follow-ups and being proactive about any symptoms can help prevent complications and maintain a good quality of life.

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