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[Conditions](https://durgical.com/en/conditions/) · [Cardiology](https://durgical.com/en/conditions/)

# Mitral valve prolapse

One or both mitral valve leaflets bulge back into the [left atrium](https://durgical.com/en/anatomy/left-atrium/) as the heart pumps. Usually harmless, it can cause a leak.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Mitral anterior leaflet](https://durgical.com/en/anatomy/anterior-leaflet-of-left-atrioventricular-valve/)
- [Mitral posterior leaflet](https://durgical.com/en/anatomy/posterior-leaflet-of-left-atrioventricular-valve/)
- [Chordae tendineae](https://durgical.com/en/anatomy/chordae-tendineae-of-right-atrioventricular-valve/)
- [Left ventricle papillary muscles](https://durgical.com/en/anatomy/superior-papillary-muscle-of-left-ventricle/)
- [Left atrium](https://durgical.com/en/anatomy/left-atrium/)
- [Left ventricle](https://durgical.com/en/anatomy/left-ventricle/)

## In the clinical exam

- [Valve murmurs: the table to know](https://durgical.com/en/clinical-exam/valve-murmurs-the-table-to-know/)
- [Dynamic auscultation: Valsalva, squatting, standing and handgrip](https://durgical.com/en/clinical-exam/dynamic-auscultation-valsalva-squatting-standing-and-handgrip/)

## Why it happens

- [Murmurs and the hemodynamics of valve disease](https://durgical.com/en/physiology/murmurs-and-the-hemodynamics-of-valve-disease/)
- [Fibrillin-1](https://durgical.com/en/biochemistry/enzymes/fibrillin-1/)
- [Glycosaminoglycans (mucopolysaccharides)](https://durgical.com/en/biochemistry/topics/glycosaminoglycans/)
- [Extracellular matrix: collagen types, elastin, ground substance](https://durgical.com/en/histology/extracellular-matrix-collagen-types-elastin-ground-substance/)
- [The heart wall, valves and conduction tissue](https://durgical.com/en/histology/the-heart-wall-valves-and-conduction-tissue/)

## What it is

Mitral valve prolapse (MVP) is the systolic displacement of one or both mitral leaflets more than 2 mm above the plane of the mitral annulus into the left atrium. It is usually caused by myxomatous degeneration of the leaflets and chordae. Most people have no symptoms, but some develop progressive mitral regurgitation.

## Who gets it

Affects about 2–3% of the general population and is the most common cause of primary mitral regurgitation needing surgery in high-income countries. It is seen in both sexes; severe regurgitation is more common in older men.

## Causes

- Primary (myxomatous) degeneration, sometimes familial
- Fibroelastic deficiency in older adults (thin leaflets, chordal rupture)
- Connective tissue disorders: Marfan syndrome, Ehlers-Danlos syndrome, osteogenesis imperfecta
- Association with adult polycystic [kidney](https://durgical.com/en/anatomy/kidney/) disease

## Risk factors

- Family history of MVP
- Connective tissue disorders
- Thin body habitus, pectus excavatum and straight back syndrome (associations)

## Pathophysiology

Myxomatous change thickens and lengthens the leaflets and [chordae tendineae](https://durgical.com/en/anatomy/chordae-tendineae-of-right-atrioventricular-valve/). During systole the redundant leaflets billow into the left atrium, and if coaptation fails mitral regurgitation results. Anything that reduces left ventricular volume (standing, Valsalva) makes the prolapse occur earlier; increasing volume (squatting) delays it. Chordal rupture can cause sudden severe regurgitation (flail leaflet).

## Classification

- Classic (leaflet thickness at least 5 mm) versus non-classic MVP
- With or without mitral regurgitation (mild, moderate, severe)
- Barlow disease (diffuse myxomatous excess tissue) versus fibroelastic deficiency

## Symptoms and signs

- Usually none; often found on examination or echocardiography
- Palpitations from premature beats or arrhythmias
- Atypical [chest](https://durgical.com/en/anatomy/region/chest/) pain, fatigue or anxiety (not clearly caused by MVP)
- Dyspnoea and reduced exercise tolerance when significant regurgitation develops
- Auscultation: mid-systolic click, often followed by a late systolic murmur at the apex

## Red flags

- Sudden severe dyspnoea or pulmonary oedema (chordal rupture with acute regurgitation)
- Syncope or sustained palpitations (ventricular arrhythmia)
- Fever with a new or changing murmur (infective endocarditis)
- Sudden focal neurological deficit (embolic stroke)

## Diagnosis

**Clinical**
A mid-systolic click with or without a late systolic murmur at the apex. With Valsalva or standing the click comes earlier and the murmur lengthens; with squatting or handgrip the click moves later.

**Tests**
ECG is often normal; it may show premature beats or non-specific ST-T changes. Ambulatory ECG for palpitations or syncope.

**Imaging**
Transthoracic echocardiography is the diagnostic test: it confirms prolapse, measures leaflet thickness and grades regurgitation and left ventricular size and function. Transoesophageal echocardiography to plan repair; cardiac MRI for ventricular fibrosis in selected patients.

## Differential diagnosis

- Other causes of mitral regurgitation (rheumatic, ischaemic, functional)
- Hypertrophic cardiomyopathy (murmur also increases with Valsalva)
- Tricuspid valve prolapse
- Anxiety or panic disorder as a cause of palpitations and chest pain

## Goal of treatment

Reassure patients with uncomplicated prolapse, follow regurgitation over time, and repair the valve before irreversible left ventricular damage.

## Treatment

**Lifestyle**
Reassurance and education for most patients; normal activity is usually allowed; reducing caffeine and stimulants may help palpitations.

**Medical**
Beta-blockers for symptomatic palpitations; heart failure therapy and anticoagulation when atrial fibrillation or heart failure develops.

**Surgical**
Mitral valve repair (preferred over replacement) for severe symptomatic regurgitation or asymptomatic severe regurgitation with left ventricular dysfunction or dilation, new atrial fibrillation or pulmonary hypertension.

**Procedure**
Transcatheter edge-to-edge repair for patients with severe regurgitation at high surgical risk.

**Follow-up**
Periodic echocardiography depending on regurgitation severity; good dental hygiene. Routine endocarditis prophylaxis is not recommended for MVP alone.

## Complications

- Progressive mitral regurgitation and heart failure
- Chordal rupture with acute severe regurgitation
- Atrial fibrillation
- Infective endocarditis
- Ventricular arrhythmias and rare sudden death («arrhythmic MVP»)

## Prognosis

Excellent for most people, with a normal life expectancy. Risk rises with thick leaflets, moderate or severe regurgitation, reduced ventricular function and older age. Early valve repair restores near-normal survival.

## Prevention

- No way to prevent primary MVP
- Regular follow-up to detect worsening regurgitation early
- Good oral hygiene to reduce endocarditis risk

## Test yourself

Think of the answer, then tap the question to see it.

## What is the classic auscultatory finding in MVP?

A mid-systolic click, often followed by a late systolic murmur at the apex.

## What happens to the click with Valsalva or standing?

It occurs earlier and the murmur becomes longer, because left ventricular volume falls.

## Which pathological change underlies most MVP?

Myxomatous degeneration of the leaflets and chordae tendineae.

## Which connective tissue disorder is classically associated with MVP?

Marfan syndrome (also Ehlers-Danlos).

## What is the preferred surgical treatment for severe regurgitation from MVP?

Mitral valve repair.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/mitral-valve-prolapse/)

## Related conditions

- [Mitral regurgitation](https://durgical.com/en/conditions/mitral-regurgitation/)
- [Marfan syndrome](https://durgical.com/en/conditions/marfan-syndrome/)
- [Infective endocarditis](https://durgical.com/en/conditions/infective-endocarditis/)
- [Atrial fibrillation](https://durgical.com/en/conditions/atrial-fibrillation/)
- [Heart failure](https://durgical.com/en/conditions/heart-failure/)
- [Ventricular tachycardia](https://durgical.com/en/conditions/ventricular-tachycardia/)
- [Ischaemic stroke](https://durgical.com/en/conditions/ischaemic-stroke/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Mitral valve prolapse](https://medlineplus.gov/ency/article/000180.htm) (MedlinePlus, US National Library of Medicine, 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/mitral-valve-prolapse/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/mitral-valve-prolapse/