Mitral valve prolapse: The evolution of a misunderstood entity

The inherent diagnostic and therapeutic challenges found in investigation of mitral valve prolapse (MVP) represent a remarkable history within the collective forces of medicine. Beginning with the "new" technology of cardiac ultrasound introduced in the 1950's, MVP's clinical relevance has represented an exciting paradigm of how technology identifies but then demands precision in the germane characterization of novel variations from the norm. Abnormalities in the anatomic structure, leaflet function and supportive left ventricular tissue have represented a compilation of sustained efforts to understand clinical outcomes; a quest that continues presently. At one time it was estimated that 5-15% of young women had MVP with some reports suggesting that as many as 35% of patients showed evidence of MVP. Efforts to introduce a more exact definition of MVP, to understand the unique valvular geometry and to link these observations into a coherent appreciation of clinical outcomes has enabled continuing progress and significant reassessment of the numbers of patients affected by MVP. This review briefly summarizes these events and explores the newest areas of investigative effort being undertaken to more effectively assist patients and to avoid the most serious clinical outcomes including complex lifethreatening ventricular dysrhythmias and sudden cardiac death.