Mitral Valve Prolapse and Its Motley Crew-Syndromic Prevalence, Pathophysiology, and Progression of a Common Heart Condition

J Am Heart Assoc. 2021 Jul 6;10(13):e020919. doi: 10.1161/JAHA.121.020919. Epub 2021 Jun 22.

Abstract

Mitral valve prolapse (MVP) is a commonly occurring heart condition defined by enlargement and superior displacement of the mitral valve leaflet(s) during systole. Although commonly seen as a standalone disorder, MVP has also been described in case reports and small studies of patients with various genetic syndromes. In this review, we analyzed the prevalence of MVP within syndromes where an association to MVP has previously been reported. We further discussed the shared biological pathways that cause MVP in these syndromes, as well as how MVP in turn causes a diverse array of cardiac and noncardiac complications. We found 105 studies that identified patients with mitral valve anomalies within 18 different genetic, developmental, and connective tissue diseases. We show that some disorders previously believed to have an increased prevalence of MVP, including osteogenesis imperfecta, fragile X syndrome, Down syndrome, and Pseudoxanthoma elasticum, have few to no studies that use up-to-date diagnostic criteria for the disease and therefore may be overestimating the prevalence of MVP within the syndrome. Additionally, we highlight that in contrast to early studies describing MVP as a benign entity, the clinical course experienced by patients can be heterogeneous and may cause significant cardiovascular morbidity and mortality. Currently only surgical correction of MVP is curative, but it is reserved for severe cases in which irreversible complications of MVP may already be established; therefore, a review of clinical guidelines to allow for earlier surgical intervention may be warranted to lower cardiovascular risk in patients with MVP.

Keywords: Ehlers‐Danlos syndrome; Loeys‐Dietz syndrome; MASS phenotype; Marfan; heart failure; mitral regurgitation; mitral valve prolapse.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Disease Progression
  • Ehlers-Danlos Syndrome* / diagnosis
  • Ehlers-Danlos Syndrome* / epidemiology
  • Ehlers-Danlos Syndrome* / physiopathology
  • Hemodynamics
  • Humans
  • Loeys-Dietz Syndrome* / diagnosis
  • Loeys-Dietz Syndrome* / epidemiology
  • Loeys-Dietz Syndrome* / physiopathology
  • Marfan Syndrome* / diagnosis
  • Marfan Syndrome* / epidemiology
  • Marfan Syndrome* / physiopathology
  • Mitral Valve Insufficiency / diagnosis
  • Mitral Valve Insufficiency / epidemiology
  • Mitral Valve Insufficiency / physiopathology
  • Mitral Valve Insufficiency / surgery
  • Mitral Valve Prolapse* / diagnosis
  • Mitral Valve Prolapse* / epidemiology
  • Mitral Valve Prolapse* / physiopathology
  • Mitral Valve Prolapse* / surgery
  • Myopia* / diagnosis
  • Myopia* / epidemiology
  • Myopia* / physiopathology
  • Prevalence
  • Risk Factors
  • Skin Diseases* / diagnosis
  • Skin Diseases* / epidemiology
  • Skin Diseases* / physiopathology
  • Treatment Outcome

Supplementary concepts

  • MASS syndrome