What Is Mitral Valve Prolapse?

Mitral valve prolapse (MVP) is a common heart valve condition that affects about 2-3 out of every 100 people. The mitral valve is like a door between two chambers on the left side of your heart. In MVP, this "door" doesn't close properly—one or both of the valve flaps bulge backward when your heart beats.

Most people with MVP live normal, healthy lives and never have serious problems. However, doctors have recently learned that a small group of patients with MVP can develop dangerous heart rhythm problems.

How Do Doctors Diagnose MVP?

The main test for MVP is an ultrasound of the heart called an echocardiogram. This test uses sound waves to create pictures of your heart beating. Doctors look for valve flaps that bulge back more than 2 millimeters (about the thickness of two pennies stacked together). They also check if the valve flaps are thicker than normal—5 millimeters or more means they're abnormally thick.

A newer imaging test called cardiac MRI (magnetic resonance imaging) helps doctors see even more detail. This test is especially important because it can show scar tissue in the heart muscle, which is a warning sign for dangerous heart rhythms. The MRI can also show a condition called mitral annular disjunction (MAD), where the valve separates from the heart muscle in an abnormal way.

Who Is at Risk for Heart Rhythm Problems?

While most people with MVP don't have serious complications, doctors have identified a specific high-risk pattern they call "arrhythmic MVP." This pattern is more common in young women and includes several warning signs:

• Both valve flaps bulge backward (not just one)
• The valve flaps are thick and long
• Abnormal heart rhythms show up on heart monitors
• Changes in the heart's electrical pattern (called T-wave inversion) on an EKG
• Scar tissue in the heart muscle visible on MRI
• Mitral annular disjunction (MAD)

Can You Die From MVP?

The risk of sudden cardiac death in MVP patients ranges from 0.2% to 1.9% per year, which means 2 to 19 out of every 1,000 people with high-risk MVP might experience this serious complication annually. This is why identifying who is at higher risk is so important.

What Causes the Heart Rhythm Problems?

Scientists have discovered that heart rhythm problems in MVP happen because of a combination of factors. The abnormal valve creates mechanical stress—like pulling on a rope—that stretches the heart muscle and the structures that support the valve. Over time, this stretching can cause scar tissue to form, especially in specific areas at the bottom of the heart and in the papillary muscles (small muscle structures that help the valve work).

This scar tissue, combined with the ongoing mechanical stress, creates the perfect conditions for dangerous heart rhythms to start.

How Is MVP Treated?

Most people with MVP only need reassurance and regular check-ups. If you have MVP with no significant leaking of the valve and no symptoms, you might only need to see your doctor every 3-5 years without needing repeated ultrasounds.

For people with severe valve leaking, surgery to repair the valve is the only cure. Valve repair is better than valve replacement, and when done before symptoms develop or the heart weakens, it can restore normal life expectancy. Doctors recommend surgery when:

• You have symptoms like shortness of breath
• Your heart starts to weaken
• You develop an irregular heartbeat called atrial fibrillation
• Pressure builds up in your lungs

Currently, there are no medications that can prevent MVP from getting worse, though scientists are researching potential treatments.

For patients with the high-risk arrhythmic pattern, doctors may recommend:

• More frequent monitoring with heart rhythm monitors
• Advanced imaging with cardiac MRI to check for scar tissue
• In some cases, an implantable defibrillator (a device that can shock the heart back to normal rhythm if needed)
• Possibly earlier valve surgery, even without severe leaking

What Is The MitraClip?

The MitraClip is an FDA-approved treatment for people with severe, symptomatic mitral valve leakage (primary mitral regurgitation) who are considered too high-risk for open-heart surgery, including some patients with mitral valve prolapse. It works best when the valve anatomy meets specific criteria, such as a flail gap of 10 mm or less and a width of 15 mm or less, though more than one clip may be needed for larger leaks.

ertain valve shapes are not good candidates for MitraClip, including commissural prolapse, Barlow’s disease, and valve leaflet holes or splits, while leaks located in the middle of the valve (P2-A2) are the most suitable. Studies show that MitraClip is generally safe and can improve symptoms, with early survival rates similar to surgery in high-risk patients, but it is not as durable as surgical repair. Clinical trials have found higher rates of ongoing moderate-to-severe leakage and a greater need for repeat procedures or later surgery in MitraClip patients compared with those who undergo surgical repair, even though hospital stays are often shorter.

Because results depend heavily on valve anatomy and patient risk, expert guidelines recommend that MitraClip be used only in carefully selected high-risk patients evaluated by a specialized heart team, with echocardiography playing a key role in determining whether the procedure is appropriate.

Clinical outcomes demonstrate safety but reduced durability compared to surgery. The EVEREST trials showed that MitraClip led to symptom improvement in high-risk patients with primary mitral regurgitation, with comparable 30-day mortality to surgery (6% in both groups). However, patients treated with MitraClip had higher rates of residual moderate-to-severe mitral regurgitation (57% vs 24% with surgery) and increased need for subsequent surgery (27.9% vs 8.9%). A comparative study of patients with degenerative mitral valve prolapse and previous cardiac surgery found that while MitraClip had shorter hospital stays (2 vs 7 days), it was associated with significantly higher recurrent moderate or severe mitral regurgitation at discharge (43.1% vs 5.4%) and at 1 year (66.7% vs 33.3%), with lower freedom from reintervention.

Careful patient selection using a heart team approach is essential. The American College of Cardiology and partner societies recommend that MitraClip be considered only for high-risk surgical patients evaluated by a multidisciplinary team experienced in treating mitral valve disease. Echocardiography is the mainstay for patient selection and procedural guidance, assessing mechanism of regurgitation, valve anatomy, and suitability for clip placement. The 2012 European guidelines and current ACC/AHA guidelines endorse MitraClip as a Class IIa recommendation (considered reasonable) for high-risk patients with degenerative mitral regurgitation who are not good candidates for conventional surgery.

The Bottom Line

Mitral valve prolapse is very common and usually harmless. However, recent research has helped doctors identify a small group of patients who need closer monitoring because they're at higher risk for dangerous heart rhythms. The key is using the right combination of tests—including echocardiograms and sometimes cardiac MRI—to identify who needs extra attention and who can simply be reassured.

If you or someone you know has been diagnosed with MVP, talk to your cardiologist about whether you have any of the high-risk features. Most people with MVP will live completely normal lives, but knowing your individual risk helps ensure you get the right level of care.