Mitral valve prolapse (MVP) is a very common heart condition. It happens when
one of the heart's valves doesn't work properly.
MVP can be frightening because it involves the heart and can occur with sharp chest
pain, but it is not a critical heart problem.
Because MVP often doesn't cause symptoms or interfere with everyday life, in many
cases it isn't diagnosed until adulthood. But with kids who are diagnosed, it's important
to know what symptoms can go with MVP, so you can distinguish them from signs of any
other more serious heart issues.
What Is the Mitral Valve?
To understand mitral valve prolapse, it's helpful to review some basics about the
way a healthy heart works.
The heart is made up of four distinct chambers: two atria (the two upper chambers)
and two ventricles (the two lower chambers).
During circulation, blood flows from all over the body into the heart's right
From there, the blood travels to the right ventricle, which pumps the blood to
the lungs to receive oxygen.
Once the blood has been infused with oxygen, it returns from the lungs to the
heart's left atrium.The oxygen-rich blood then passes into the left ventricle, which
pumps it out to the body through a large blood vessel known as the aorta.
Where Is The Mitral Valve?
The mitral valve sits between the left atrium and the left ventricle
and helps control the flow of blood as it passes from the left atrium into the left
ventricle. The valve has two flaps of tissue — known as leaflets
— that open and close together like a pair of swinging doors. Each time the
heart beats, the left ventricle pumps blood out to the body and the flaps of the mitral
valve swing shut to prevent the blood in the ventricle from flowing backward into
the left atrium.
In cases of MVP, one or both of the mitral valve's leaflets may flop back and bulge
into the atrium when they are shut, a bit like a balloon. This may happen because
one of the flaps is abnormally shaped or a little too big.
Sometimes, when the flaps do not close evenly, blood can leak back into the left
atrium. This is called mitral regurgitation. In all of us, a tiny
amount of mitral regurgitation may be normal. When there is more than a little leakage,
the doctor may hear a whooshing sound — a heart
murmur — between the normal lub-dub sounds of the heartbeat. (Because of
these sounds, MVP is sometimes called click-murmur syndrome, floppy valve syndrome,
or balloon mitral valve.)
In most cases, the cause of MVP is unknown. Sometimes kids are born with the condition.
In other cases, it develops after some sort of inflammatory condition, like endocarditis
(infection of the inner lining of the heart) or rheumatic fever (inflammation that
can affect the joints and the heart).
MVP may be diagnosed in people who have other health conditions that affect the
body's connective tissues, such as Marfan
syndrome. Some research has shown that kids with MVP might be more likely to also
have an arrhythmia,
an irregular heartbeat.
Signs and Symptoms
Many people with MVP have no symptoms and no complaints. In some cases, though,
the flaps of the mitral valve make a clicking sound when they close, like when you
flick or snap a towel, and it is simply called a "click." A doctor might be able to
hear this noise when listening to the heart with a stethoscope and discover MVP that
Someone who has MVP and mitral regurgitation also may have a heart murmur, the
sound caused by some blood moving backward into the left atrium. When a click and
murmur are heard together, the click happens first (as the flaps close and flop back),
followed by the murmur (the noise of the whirling blood as it leaks back into the
atrium through the improperly closed valve).
Kids with MVP might have:
dizziness or lightheadedness
shortness of breath or trouble breathing after exertion
a feeling that the heart is skipping beats or beating very quickly
chest pain that comes and goes
The chest pain is often described as sharp but can vary from person to person.
And it isn't always clear whether chest pain in kids is caused by the MVP or by something
else, such as stomach reflux.
Chest pain in kids is not usually dangerous. However, call your doctor if your
child has chest pain that:
consistently occurs during physical exertion (exercise or sports)
creates pressure and a crushing sensation
occurs with other symptoms (palpitations that last more than a few seconds, dizziness,
fainting, or shortness of breath)
Diagnosis and Treatment
In most cases, MVP is diagnosed during a routine exam when a doctor listens to
the heart with a stethoscope and hears a different sound. If the doctor hears a click
or a murmur that indicates MVP, he or she may refer your child to a pediatric cardiologist,
a doctor who specializes in diagnosing and treating heart conditions in kids.
The cardiologist will do a thorough physical exam and listen to the heart. Then
he or she may order tests — including an echocardiogram(echo)
and an electrocardiogram(EKG or ECG) — to
find out what's causing the sound. An echo uses sound waves to create a picture of
the heart and its blood flow, and an EKG records electrical activity produced by the
heart. If a child has MVP, the bulging valve flaps will probably be seen on the echo
when the heart beats.
Kids who are diagnosed with MVP won't need medical treatment. In some cases
where MVP causes significant regurgitation, doctors may prescribe blood pressure medication
to control how hard the heart muscle works. (With blood leaking back into the atrium,
the heart works harder to pump the normal amount of blood out to the body.)
A child who has an arrhythmia (an abnormal heart rhythm) in addition to MVP may
need to take medicine to help regulate the heart's rhythm. However, this is not common
Leakage due to MVP may continue over years; very rarely, a child might need surgery
to repair a very leaky mitral valve.
Preventing Heart Infection
In a child with MVP with regurgitation (leaking), there is a small risk of a bacterial
infection of the heart valve (infective endocarditis). It very rarely happens during
childhood. Many times the bacteria that cause this kind of infection start out living
in the mouth and from there enter the bloodstream through the gums and then, even
more rarely, cause the infection.
For many years, doctors recommended giving a dose of antibiotics before dental
work and surgical procedures as a precaution. Following a review and published report
by The American Heart Association in 2007, it is no longer recommended that antibiotics
be given, as they were not found to reliably protect the patient.
Instead, your child should focus on good mouth care by:
Brushing his or her teeth twice a day, morning and night (after eating).
Flossing the teeth each night.
Seeing the dentist every 6 months.
Your child's cardiologist will let you know if there are reasons to do something
other than follow these guidelines.
Caring for a Child With MVP
Kids with MVP who have no other medical conditions usually require no special care.
A child with MVP who plays competitive sports will be able to continue doing so as
long there's no mitral regurgitation or active symptoms from the MVP. A child who
does have regurgitation or symptoms will have to be cleared by the doctor to participate
in sports. This may involve some additional tests.
Although any heart condition can be frightening, mitral valve prolapse likely will
not have any effect on your child's everyday life and activities. If you have any
questions or concerns, speak with your doctor.