Mitral Valve Prolapse

Some kids and many grown-ups have something called mitral valve prolapse (say: MY-trul VALV PRO-laps). For most people, it’s a heart problem that isn’t much to worry about.

What Is the Mitral Valve?

The mitral valve is part of the heart. Remember how the heart works?

• A normal heart has four chambers, two atria (say: AY-tree-uh) and two ventricles (say: VEN-trih-kulz). Each side of the heart has an atrium and a ventricle.
• Blood comes from all over the body into the heart’s right atrium.
• From there it goes to the right ventricle. The right ventricle pumps the blood to the lungs, where it picks up oxygen.
• Next, the blood returns from the lungs to the heart’s left atrium.
• From the left atrium it goes into the left ventricle, which pumps the blood out to the body so the body can use the oxygen in the blood.

The mitral valve is between the heart’s left atrium and left ventricle. It has two flaps that open and close together like a pair of swinging doors. When the heart beats, the left ventricle pumps blood out to the body and the flaps swing shut. This keeps the blood in the ventricle from going back into the left atrium.

What Is Mitral Valve Prolapse?

In someone who has mitral valve prolapse (MVP), one or both of the valve’s flaps buckle up (or swing upward) slightly into the atrium as they close. In some kids, these flaps still close completely. In some other kids, they may not shut properly. When the flaps don’t close correctly, blood can leak back into the left atrium. This can happen because the flaps are too floppy or too big or have the wrong shape.

Usually MVP doesn’t cause any problems. Almost all kids who have it lead totally normal lives. Lots of times people don’t even know they have it or don’t find out until they’re adults. It’s not discovered in kids very much. Sometimes people are born with MVP, others develop it later in life. Doctors often don’t know why someone has MVP.

Signs and Symptoms

Most kids with MVP have no complaints and no symptoms. In some kids, the flaps of the mitral valve make a clicking sound when they close. A doctor may hear this when listening to the heart with a stethoscope. Someone who has MVP and a little blood leaking back through the valve also may have a heart murmur. A heart murmur is the sound caused by the leaking blood.

Kids with MVP may also:

• feel dizzy or lightheaded
• feel anxious
• be really tired
• get out of breath when playing or exercising
• feel that their heart is skipping beats or beating very fast
• have chest pain
• have fainting episodes

What Will the Doctor Do?

Most kids who learn they have MVP find out about it during a regular checkup. The doctor might be listening to the kid’s heart and hear a click or a murmur. The doctor then will send the kid to a pediatric cardiologist (say: pee-dee-AT-rik kar-dee-AHL-uh-jist), a doctor who treats heart conditions in kids.

First, the cardiologist will talk to you and your parents for a while and ask some questions about your health. Then he or she will examine you and listen to your heart. The doctor also may order some tests, like an echocardiogram (say: ek-oh-KAR-dee-uh-gram) and an electrocardiogram (say: ee-LEK-troh-kar-dee-uh-gram) (ECG or EKG). The tests can help the doctor find out what’s causing the different sound in your heart.

These tests don’t hurt. For an ECG, you will lie down and a doctor or nurse will put some small stickers on your chest. These stickers are connected to wires and a machine that records the electricity coming from your heart. The machine will draw squiggly lines representing your heartbeats for the cardiologist to look at. This test usually takes about 10 minutes.

An echocardiogram (echo for short) uses sound waves to make a picture of the heart and the blood flowing through it. For this test, you will lie down and the doctor or a specially trained person (called a sonographer) will put some gel (like jelly) on your chest. The gel helps make the picture of your heart clearer, and it might feel a little cool and sticky.

Then the person doing the test will press very gently on your chest with a thick plastic wand and move this wand around and around on the skin over your heart. As it moves, the wand takes pictures of your heart. An echo takes longer than an ECG — about 30 minutes. (Often they have a video you can choose to watch to keep from being bored.) If you have MVP, the doctor should be able to see the floppy valve on this picture.

If the doctor discovers that you do have MVP, you probably won’t need any treatment.

In a few cases, kids may take a medicine to help the heart pump blood out to the body or and sometimes to give the heart a more regular heartbeat. Very rarely, a kid might have surgery to fix a mitral valve that’s really leaky.

MVP Can Lead to Infections

Bacteria (a type of germ) travel through the blood every day, and once in a while they can stick to the floppy mitral valve, causing an infection in the heart. This kind of infection is called bacterial endocarditis (say: bak-TEER-ee-ul en-doh-kar-DYE-tus).

The good news is that it’s very rare for this to happen to a kid and it doesn’t seem to be a problem at all in kids if the floppy mitral valve isn’t leaking.

In the past, kids with MVP and leaky valves were told to take a big dose of antibiotics (a medicine that kills germs) before every dentist visit or before any surgery. Now we know that this is not necessary. What is very important is to take good care of your teeth every day.

You may wonder what taking care of your teeth has to do with keeping your heart healthy. If you have unhealthy gums (gum disease or gingivitis), your gums become inflamed or irritated. Bacteria that normally live in your mouth can then sneak more easily through your irritated gums and go into your bloodstream.

So, make sure you:

• brush your teeth at least twice a day — morning and night after you eat
• learn how to floss your teeth to rub away those nasty bacteria before you go to sleep
• see your dentist every 6 months

This is the best way to prevent infection in your heart.

Can You Play?

If you have MVP and no other problems, you won’t have to do anything special to take care of yourself. You may have to see your cardiologist every year or two. During these visits, you might have more echo tests to let the doctor look at your heart and mitral valve. Your doctor probably will let you know if it’s OK to play sports and do all your usual activities.

If you have symptoms, like a fainting spell or feeling your heart is beating really fast, check with your doctor about sports. You may need some extra tests before you get the OK.

Most kids with MVP can play sports without a problem. In other words, you can still be the MVP (most valuable player) even if you have MVP (mitral valve prolapse)!