Not a single drop of blood can ever leak from our ventricle to atria in entire life time. During the phase of systole, left ventricle will generate force to send blood into aorta. This will also put substantial stress on mitral valve leaflets but the bicuspid mitral valve leaflets are able to hold their position all thanks to infrastructure of chordae tendinae and papillary muscles attached underneath the valve.

But in MVP there is undue bulging of leaflets of mitral valve into LA due to lose and lax chordae tendinae. I want you to imaging these chordae tendinae as rubber bands attached to undersurface of valve leaflets. Now due to undue stretching of these chordae tendinae, vibrations are set up that are auscultated by you as mid systolic clicks.

Do not confuse with ejection sound/click which occurs due to opening of aortic and pulmonic valves.

So why are we worried about this condition

1. Defective coaptation of leaflets that will cause murmur and pulmonary edema
2. Undue stress on papillary muscles that will cause ischemia of adjacent myocardium
3. Worst case scenario: Snapping of chordae tendinae causing incompetent valve. This will cause blood to back up into lung circulation causing pulmonary edema.

Causes of MVP

Clinical features

1. Asymptomatic
2. Chest pain due to ischemia of myocardium
3. Dyspnea. Orthopnea due to incompetent valve causing pulmonary edema
4. Arrythmias: PVC / Ventricular bigeminy, Ventricular tachycardia, PSVT and Atrial fibrillation

On examination

1. Mid systolic click
2. Late systolic murmur
   • (Do not mix with harsh ejection systolic murmur of aortic stenosis.)
3. Changes in murmur with squatting and standing
   • Squatting: shorter duration
   • Standing: longer duration

Investigation of choice:

Echocardiography shows anterior or posterior mitral leaflet to prolapse greater than 2 mm in mitral annular plain.

Treatment:

Mitral valve repair with beta blockers is the mainstay of treatment

#NEETPG #FMGE #INICET