Mitral valve prolapse is common malady


January 03, 1995|By Dr. Modena Wilson and Dr. Alain Joffe | Dr. Modena Wilson and Dr. Alain Joffe,Special to The Sun

Q: My 16-year-old son has been diagnosed with mitral valve prolapse. What is it? Will it affect his physical activity? Why does he need to take antibiotics before medical procedures?

A: Mitral valve prolapse (MVP) is one of the most common "abnormalities" of the heart among teen-agers. Some people don't even consider it a disease because it is so very common (affecting as many as 5 percent to 10 percent of people).

To explain MVP, we must first tell you a little about the mitral valve. Thisvalve separates the upper (atrium) and lower (ventricle) chambers of the left side of the heart and prevents blood from flowing backward from the ventricle into the atrium as the heart contracts. Given that the ventricle generates tremendous pressure as it contracts and pumps blood to the aorta, the mitral valve must be able to withstand such pressure in order to prevent blood from going back up into the atrium.

For reasons not currently understood, the two leaflets of the mitral valve undergo changes that makes them thicker but floppier and less able to form a tight seal between the two chambers. The leaflets may billow up into the atrium and some blood may actually go back up there as well. Some individuals with MVP may have other associated physical characteristics.

People with MVP may experience rapid or irregular heartbeat, chest pain, shortness of breath with exercise, fatigue, lightheadedness or even fainting spells. Some report frequent attacks of anxiety and panic.

However, an individual may have no symptoms and be diagnosed when, during a routine checkup, a physician hears an extra heart sound -- called a "click" -- or a certain kind of murmur that was not present previously.

Virtually everyone with MVP can lead a normal life. If your son is not having symptoms from his MVP, he should not be restricted in his physical activity. Those individuals with symptoms may need medication to control them but should then be able to lead a normal life.

Because the mitral valve is not normal in MVP and there may be some associated turbulent flood flow around it, the valve is at increased risk for becoming infected should bacteria gain access to the bloodstream, even if only for a few minutes. This phenomenon, called bacteremia, occurs frequently but transiently, during certain kinds of surgeries.

Hence, some patients, particularly those who have blood regurgitating from the left ventricle up into the left atrium, require antibiotics before and shortly after certain surgical procedures to prevent bacteria from attaching to the valves, multiplying and damaging them.

Dr. Wilson is director of general pediatrics at Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.

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