Quick Questions: Mitral Valve Prolapse

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Dr. Marc Gillinov, MD:

Hello, I'm Dr. Marc Gillinov, the Chair of Thoracic and Cardiovascular Surgery at Cleveland Clinic, where I am a heart surgeon. Today, I'm going to talk a little bit about mitral valve prolapse and answer the most common questions that people have about mitral valve prolapse. The first question people have is, "What is it? What is mitral valve prolapse?" The mitral valve is one of four valves inside the heart, and the valves are designed to keep blood flowing in one direction and prevent it from going backward. The mitral valve has two leaflets or flaps that meet, open, close, open, close. If one part of one of the leaflets or flaps moves too much or becomes a little bit floppy, we call that mitral valve prolapse. Mitral valve prolapse then means one part of the mitral valve, a heart valve, is a little bit loose or floppy. This is a very common condition.

About 2 to 3% of all Americans have mitral valve prolapse, meaning there are about nine million people in the US who have this condition of mitral valve prolapse. The good news is it's not serious. It is not a problem in the overwhelming majority of people. Most people with mitral valve prolapse never need heart surgery, never have any sort of problems with their heart.

How do you know if you've got it? It has a distinctive sound when someone listens with a stethoscope. So the first step to finding out, “do I have mitral valve prolapse?” is just to get a physical and have someone listen to your heart. If the person listens to your heart and says, "I hear something that might be mitral valve prolapse," you might get an echocardiogram or an ultrasound of the heart. The echocardiogram or ultrasound is the definitive way to diagnose mitral valve prolapse. The echocardiogram actually shows the valve moving and can show how the valve has prolapsed, meaning part of it is a little bit loose or floppy.

If you have mitral valve prolapse though, and even if you've had an echocardiogram that says, "Yes, you have mitral valve prolapse," you should not worry, because, again, almost certainly nothing's ever going to happen. If you have mitral valve prolapse, you should get a physical once a year, and at that physical, the provider will listen to your heart. What is he or she listening for? In a small percentage of people, mitral valve prolapse progresses to a leaking valve. The leaking valve, also called mitral regurgitation, the leaking valve is the one that could need treatment. Again, most people with mitral valve prolapse do not progress, but if you have mitral valve prolapse, have someone listen to your heart once a year and the other 364 days a year, forget about your heart.

Now, what if someone listens and they hear a murmur? A murmur is a sound that the heart makes when there is something going wrong with a heart valve. A murmur heard with a stethoscope is something like listening to a river that has white water or turbulent flow. Think of a river or a stream that's flowing smoothly. It doesn't make much noise. Now imagine whitewater, big raging currents, whitewater rocks, that makes a lot of noise. That's turbulent flow, and turbulent flow is like a murmur in the heart. So, if someone listens to your heart and says, "You have a murmur." That means you need an echocardiogram. The echocardiogram will say, "What caused that murmur? What is causing this noisy blood flow, this turbulent blood flow in the heart?" In a small number of people with mitral valve prolapse, a murmur happens and the murmur represents a leaking mitral valve.

A leaking mitral valve, mitral regurgitation is another name for leaking mitral valve, a leaking mitral valve can require repair. A small leak, get an echo once a year. A big leak, what we would call a severe leak, means that you need to get it fixed because if you have mitral regurgitation with a big leak to the valve, if you leave that alone, if you leave the leak alone, even if you feel fine, leaving the leak alone is going to cause heart damage.

How do we fix the valve? The gold standard for fixing a leaking mitral valve, mitral regurgitation, the gold standard is surgery. 99% of the time here at Cleveland Clinic, we can actually repair your own leaking valve, meaning you don't get a pig valve, you don't get a metal valve, you get your own valve repaired. If you get your own valve repaired, as we do here at the Cleveland Clinic, you will have a normal life and a normal life expectancy.

Now, one of the biggest advantages to valve repair is that we can do it now with a surgical robot. That means we can make a little incision on the right side of the chest. It is the right side. A lot of people think we go to the left. You go to the right side of the chest to fix the mitral valve, but a little incision with the surgical robot and a special camera, very well-designed instruments, and we can fix your valve.

In fact, I made rounds this morning. I saw someone who had robotic mitral valve repair yesterday. She looks great. I said, "How do you feel?" And she said, "I'm a little bit tired, but I can't believe I had heart surgery yesterday. I feel like I'm ready to get out of the hospital today." She'll probably leave the hospital in a couple of days. We'll get her up and walking around, but the main point is she had a very safe operation. She's doing great. She's having her scrambled eggs and orange juice this morning, the day after robotic mitral valve surgery.

What does she have to do for her valve over the next few years? She's had a mitral valve repair for mitral valve prolapse that caused a leak. She'll get an echo once a year. She takes antibiotics when she goes to the dentist, and that's about it. She'll have a normal life.

The bottom line is, if you have mitral valve prolapse, don't worry. The odds are very high your mitral valve prolapse will never lead to anything, won't affect your life. By the way, you do not have to take antibiotics for the dentist if you have mitral valve prolapse. You take antibiotics only if you've had one of us, a heart surgeon, work on the valve. But simple mitral valve prolapse, you don't need antibiotics.

So, simple mitral valve prolapse, no leak, don't worry. Have someone listen to your heart once a year. The rest of the time, forget about it. If your mitral valve begins to leak, causing a murmur, get an echo once a year. If the leak becomes a big leak, a severe leak, get it fixed.

When you get it fixed, which means surgical repair, get that repair done someplace that does this a lot. Here at Cleveland Clinic, we do about 1,200 mitral valve operations a year, so it is every day. Get it fixed by a team that knows how to do it through a little incision with a surgical robot so that you recover quickly, get on with your life, you're happy, and you have a completely normal life.

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