Harvard Heart Letter

The flap over mitral valve prolapse

A billowing mitral valve poses trouble mainly when it gets leaky.

It has been a long, strange trip for mitral valve prolapse. Since this valve abnormality gained its name in the early 1960s, it has been called both dangerous and benign, widespread and uncommon. The title of an editorial in the British Medical Journal summed up the confusion like this: "Mitral valve prolapse: harbinger of death or variant of normal?"

The uncertainty stemmed from the overenthusiastic use of echocardiography after it entered mainstream use in the 1980s. Many people were diagnosed with mitral valve prolapse when they actually had normal valves that were simply shaped differently from what doctors thought was correct. Refinements to echocardiography and better knowledge of the geometry of the valve have limited the diagnosis. Yet the confusion and the often unnecessary worry that it generates still linger.

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