Involves myxomatous degeneration of the mitral valve leaflets → eventually leads to structural incompetence and superior displacement of one or both mitral leaflets into the left atrium (LA) during systole ¹
Estimated to affect 2% to 3% of individuals¹
Physical Exam
- 🩺: mid‐systolic “click” heard best at the apex
  - presence of a late systolic or holosystolic murmur can suggest the presence of MR
Diagnosis
- Echo (gold standard)
Patients who experience an increased burden of premature ectopic beats (such as PVCs) are at an increased risk of developing more severe, even life‐threatening arrhythmias.¹

Barlow disease

diffuse, myxoid degeneration of the MV → excess tissue in multiple valve segments, including leaflets and chordae → (typically) both anterior and posterior MVP, as well as annular dilation
Compared to fibroelastic deficiency, Barlow disease is less frequently associated with chordal rupture.

Fibroelastic deficiency

Caused by abnormalities in connective tissue → leaflet redundancy, chordal thinning and elongation → MVP
- The thinned and elongated tendinous chords in MVP are prone to rupture
Chordal rupture may lead to flail leaflet and a sudden ↑ in MR volume (acute MR)

Morningstar, J. E., Nieman, A., Wang, C., Beck, T., Harvey, A., & Norris, R. A. (2021). Mitral Valve Prolapse and Its Motley Crew‐Syndromic Prevalence, Pathophysiology, and Progression of a Common Heart Condition. Journal of the American Heart Association, 10(13). https://doi.org/10.1161/jaha.121.020919 ↩ ↩² ↩³