Mitral Valve Prolapse
EVALUATION AND MANAGEMENT OF THE ASYMPTOMATIC PATIENT
CLASS I
(1) Echocardiography is indicated for the diagnosis of MVP and assessment of MR, leaflet morphology, and ventricular compensation in asymptomatic patients with physical signs of MVP.
CLASS IIa
(1) Echocardiography can effectively exclude MVP in asymptomatic patients who have been diagnosed without clinical evidence to support the diagnosis.
(2) Echocardiography can be effective for risk stratification in asymptomatic patients with physical signs of MVP or known MVP.
CLASS III
(1) Echocardiography is not indicated to exclude MVP in asymptomatic patients with ill-defined symptoms in the absence of a constellation of clinical symptoms or physical findings suggestive of MVP or a positive family history.
(2) Routine repetition of echocardiography is not indicated for the asymptomatic patient who has MVP and no MR or MVP and mild MR with no changes in clinical signs or symptoms.
EVALUATION AND MANAGEMENT OF THE SYMPTOMATIC PATIENT
CLASS I
(1) Aspirin therapy (75 to 325 mg per day) is recommended for symptomatic patients with MVP who experience cerebral transient ischemic attacks.
(2) In patients with MVP and atrial fibrillation, warfarin therapy is recommended for patients aged greater than 65 or those with hypertension, MR murmur, or a history of heart failure.
(3) Aspirin therapy (75 to 325mg per day) is recommended for patients with MVP and atrial fibrillation who are less than 65 years old and have no history of MR, hypertension, or heart failure.
(4) In patients with MVP and a history of stroke, warfarin therapy is recommended for patients with MR, atrial fibrillation, or left atrial thrombus.
CLASS IIa
(1) In patients with MVP and a history of stroke who do not have MR, atrial fibrillation, or left atrial thrombus, warfarin therapy is reasonable for patients with echocardiographic evidence of thickening (5 mm or greater) and/or redundancy of the valve leaflets.
(2) In patients with MVP and a history of stroke, aspirin therapy is reasonable for patients who do not have MR, atrial fibrillation, left atrial thrombus, or echocardiographic evidence of thickening (5 mm or greater) or redundancy of the valve leaflets.
(3) Warfarin therapy is reasonable for patients with MVP with transient ischemic attacks despite aspirin therapy.
(4) Aspirin therapy (75 to 325mg per day) can be beneficial for patients with MVP and a history of stroke who have contraindications to anticoagulants.
CLASS IIb
(1) Aspirin therapy (75 to 325 mg per day) may be considered for patients in sinus rhythm with echocardiographic evidence of high-risk MVP.
JACC Vol. 52, No. 13, 2008
September 23, 2008: e1-142