Imaging of Mitral Valve Prolapse: What Can We Learn from Imaging about the Mechanism of the Disease?

Ronen Durst,Dan Gilon

doi:10.3390/jcdd2030165

Abstract

Mitral valve prolapse (MVP) is the most common mitral valve disorder affecting 2%–3% of the general population. Two histological forms for the disease exist: Myxomatous degeneration and fibroelastic disease. Pathological evidence suggests the disease is not confined solely to the valve tissue, and accumulation of proteoglycans and fibrotic tissue can be seen in the adjacent myocardium of MVP patients. MVP is diagnosed by demonstrating valve tissue passing the annular line into the left atrium during systole. In this review we will discuss the advantages and limitations of various imaging modalities in their MVP diagnosis ability as well as the potential for demonstrating extra associated valvular pathologies.

Highlights

Mitral valve prolapse (MVP) is the most common mitral valve disorder affecting 2%–3% of the general population
Degenerative processes resulting in regurgitation of the mitral valve have two main phenotypes: Diffuse myxomatous degeneration, which may present as a genetic disorder, and a markedly different fibroelastic deficiency (FED) [1,26], which might be caused by an accelerated aging process
MVP imaging with Computed Tomography (CT) is possible, it should not be used as the preferred imaging modality, unless other clinical information, such as coronary evaluation, which can be provided by CT is needed

Summary

History of MVP Diagnosis

MVP is a common cardiovascular disorder, originally described in the 1960s and is considered today the most common cause of mitral regurgitation [1,2,3]. Despite the improved spatial appreciation and view standardization achieved with two-dimensional echocardiography, high diagnostic rates could still be obtained based on the assumption that the mitral annulus is planar, and that leaflet displacement relative to the annulus in any view is abnormal [15,16,17]. The three-dimensional understanding of the mitral valve shape and the new more accurate MVP diagnostic criteria have reduced the prevalence of the disease in various series to 2%–3% of the general population [3,14]. The definition of MVP is based on demonstrating the anatomical relation between mitral valve leaflet excursion into the left atrium relative to the annulus. Imaging can provide an insight into the pathology associated with valve structure as well as potential myocardial abnormalities. The purpose of this paper is to review the advantages and limitations of the various imaging modalities in diagnosing MVP and related pathologies

Echocardiography

Nuclear Imaging

Conclusions

Epidemiologic features