What is the treatment for mitral valve prolapse?
The vast majority of patients with mitral valve prolapse have an excellent prognosis and need no treatment. For these individuals, routine examinations including echocardiograms every few years may suffice. Mitral regurgitation in patients with mitral valve prolapse can lead to heart failure, heart enlargement, and abnormal rhythms. Therefore, those patients with mitral valve prolapse and regurgitation are often evaluated annually. Since valve infection, endocarditis, is a rare, but potentially serious complication of mitral valve prolapse, patients with mitral valve prolapse are usually given antibiotics prior to any procedure that can introduce bacteria into the bloodstream. These procedures include routine dental work, minor surgery, and procedures that can traumatize body tissues such as colonoscopy or gynecologic or urologic examinations. Examples of antibiotics used include oral amoxicillin and erythromycin as well as intramuscular or intravenous ampicillin, gentamycin, and vancomycin.
Patients with severe prolapse, abnormal heart rhythms, fainting spells, significant palpitations, chest pain, and anxiety attacks may need treatment. Beta-blockers, such as atenolol (Tenormin), metoprolol (Lopressor), and propranolol (Inderal), are the drugs of choice. These act by increasing the size of the left ventricle, thereby reducing the degree of prolapse. The calcium blockers verapamil (Calan) and diltiazem (Cardizem) are useful in patients who cannot tolerate beta-blockers.
Although most patients with mitral valve prolapse require no treatment or treatment with oral medications, in very rare cases, surgery (mitral valve replacement or repair) may be required. Patients who require surgery usually have severe mitral regurgitation causing worsening heart failure and progressive heart enlargement. Rarely, rupture of one or more chordae can cause sudden, severe mitral regurgitation and heart failure requiring surgical repair. Mitral valve repair is preferable, if possible, to mitral valve replacement as the surgical treatment for mitral valve regurgitation. After mitral valve replacement, lifelong blood thinning medications are necessary to prevent blood from clotting on the artificial valves. After mitral valve repair, these blood thinning medications are unnecessary. Because of the success of valve repair, it is being performed earlier in patients with mitral regurgitation, thus reducing the risk of abnormal heart rhythms and heart failure.
Rare patients with mitral valve prolapse may suffer strokes because of increased blood clotting. These patients can be treated with a combination of a blood thinner (anticoagulant) and a beta-blocker.
Again, although patients with mitral valve prolapse may experience a variety of complications, most have no symptoms and can lead healthy, active, and normal lives.
It must be emphasized that the overwhelming majority of patients with symptoms of mitral valve prolapse have bothersome but not life-threatening problems, and only a very small minority of patients go on to need surgery or other aggressive therapies. Also, the symptoms may be very episodic, and come in waves and then disappear for some time. They may be aggravated by stress, pregnancy, fatigue, other illnesses, or menstrual cycles.
Medically reviewed by Robert J. Bryg, MD; Board Certified Internal Medicine with subspecialty in Cardiovascular Disease
Bonow, Robert O., et al. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Elsevier Saunders, 2012.