Pediatric Cardiology

Mitral Valve Prolapse (MVP): Symptoms, Causes and Treatment Options

Posted on by Prof. Dr. İbrahim Cansaran TANIDIR

Mitral Valve Prolapse in children is a condition in which the mitral valve located between the left chambers of the heart stretches slightly and bulges/sags toward the left atrium at the moment of complete closure. This condition, which generally develops as a result of genetic predisposition or the structural flexibility of connective tissue, is not a disease but an anatomical variation in the functioning of the heart. Easily monitored with today’s advanced imaging methods, this condition allows most children to live healthy lives without any restrictions. Regular follow-up and evaluations performed under specialist supervision are the safest and most sufficient steps for preserving heart function; this process is not a cause for concern in children but a developmental condition that can be carefully managed.

What Is Mitral Valve Prolapse (MVP) and How Does It Affect the Functioning of the Heart?

In daily life, the heart can be compared to an extraordinary four-chambered pump that works continuously or to a two-story house. Oxygen-rich blood coming from the lungs fills the upper left chamber of the heart, namely the left atrium. This fresh blood then passes into the lower left chamber, namely the left ventricle, which provides the main muscular power of the heart and pumps blood throughout the body. Between these two chambers, there is a type of door that allows blood to flow in only one direction and prevents it from flowing backward. This moving door is called the mitral valve. In a normal and healthy heart, when the left ventricle contracts very strongly to pump blood throughout the body, the leaflets of this valve close tightly and attempt to prevent the blood from flowing backward.

However, when the valve is excessively flexible, microscopic loosening or softening occurs in the tissues forming the valve. When the heart contracts, the valve closes, but because of its flexible structure, it bulges or sags backward toward the left atrium, much like a parachute inflating in a strong wind. Sometimes the thin cords that hold this valve in place may also stretch and become unable to perform their function fully. As a result of this prolapse, the valve may not close completely, allowing a certain amount of blood to leak back into the left atrium. The heart may need to work slightly harder to compensate for this leakage. Fortunately, children’s hearts are highly resistant to such minor increases in workload and adapt easily.

The main cardiac structures involved in this process are:

  • Left atrium
  • Left ventricle
  • Valve leaflets
  • Valve cords
  • Valve annulus

How Has the Diagnosis of Mitral Valve Prolapse (MVP) Developed Throughout History?

Looking back at medical history, physicians’ efforts to understand this structural variation in the heart date back many years. Since modern imaging devices were unavailable in earlier times, the only tool used to understand the heart was the stethoscope. The characteristic short sound heard through the stethoscope, thought to occur when the valve became tense during prolapse, attracted the attention of scientists for many years. Over time, it was gradually understood that this sound originated from valve stretching, and different names began to be given to this condition. However, in the past, the diagnostic criteria were not as clear and strictly defined as they are today.

Because physicians previously made this diagnosis based only on the sounds they heard and simple symptoms, an inaccurate and exaggerated belief emerged that nearly one in every four people had this condition. This caused many people in society to unnecessarily believe they had heart disease and restrict their lives. Over time, with the invention and widespread use of echocardiography, known as heart ultrasound, the inside of the heart became visible in a live and clear manner. Thanks to the exceptional clarity provided by technology, diagnostic criteria were made stricter and standardized. It was proven that this flexibility is actually much less common in the general population. Today, even the smallest movements in children’s hearts can be measured with millimetric precision, largely preventing misdiagnosis and reassuring families.

The tools used for diagnosis from the past to the present include:

  • Stethoscope
  • Clinical observation
  • Basic X-ray
  • Heart ultrasound (echocardiography)

Into Which Structural Categories Is Mitral Valve Prolapse (MVP) Divided in Children?

Just as every child’s facial features, height, or eye color differ, the structure and flexibility pattern of the heart valve also vary considerably. Understanding these structural differences correctly is highly valuable for predicting how the condition may progress in the future and determining follow-up intervals. During structural evaluations, changes in the valve are generally examined by dividing them into two main groups.

In the first group, the valve leaflets are visibly thicker, more spongy, and longer than normal. When the heart contracts, these leaflets prolapse noticeably backward beyond the closure line. This form indicates a condition in which the valve has undergone greater physical changes and may require somewhat closer monitoring over time. In the second group, the thickness and length of the valve leaflets appear completely within normal limits, with no obvious deterioration or thickening of the tissue. Nevertheless, when the heart contracts, the valve tends to flex slightly backward. This form generally tends to follow a milder course. Whether the anterior or posterior leaflet prolapses more is examined very carefully with ultrasound because it can alter the direction of backward blood flow and fluid dynamics within the heart. Prolapse of the posterior leaflet is anatomically much more common. However, although rare, both leaflets may be involved in this stretching process.

The criteria examined during structural evaluation include:

  • Leaflet thickness
  • Leaflet length
  • Degree of flexibility
  • Direction of prolapse
  • Chordal structure

What Are the Genetic and Underlying Causes of Mitral Valve Prolapse (MVP)?

Parents frequently wonder why their child’s heart valve is so flexible. The origin of this condition largely lies in genetic predisposition and the cellular characteristics of connective tissues, which are the fundamental building blocks of the body. In most cases, this flexibility develops incidentally during the child’s growth and development and does not arise because of another disease in the body. Familial inheritance is also quite prominent; children whose mother, father, or close relatives have similar valve flexibility are relatively more likely to develop this condition.

In addition, certain rare genetic syndromes that cause all connective tissues in the body to be more flexible and weaker than normal may predispose individuals to this condition. In these genetic disorders, which may cause symptoms such as unusually flexible joints compared with peers and differences in skin structure, the heart valves are also naturally affected because they are composed of connective tissue. Rheumatic heart disease experienced many years ago may also rarely leave structural changes in the valves, but rheumatic processes generally tend to stiffen the valve and restrict its movement rather than make it more flexible. Furthermore, thanks to rapid advances in genetic science, the scientific community believes that certain specific genetic codes determining how the valve forms during cellular development in the womb play an important role in this process.

The main factors that may affect the process include:

  • Familial inheritance
  • Connective tissue characteristics
  • Incidental development
  • Genetic syndromes

What Symptoms Does Mitral Valve Prolapse (MVP) Cause in Children?

The vast majority of children with this structural variation continue their lives happily for years without experiencing any complaints, running and playing in parks. Most often, the condition is discovered incidentally during a routine school health screening or when the heart is examined during a visit for a simple cold. However, some children may tend to express this minor structural difference in their bodies through certain symptoms.

Occasional unexplained acceleration or skipped-heartbeat sensations, becoming tired more quickly than peers during physical exertion, darkening of vision, or brief dizziness when standing up suddenly are among the most commonly reported complaints. The symptom that frightens parents the most and causes them to visit emergency departments is chest pain described by the child. However, the vast majority of chest pain during childhood does not originate from the heart; it results from strain in the chest muscles, pressure on cartilage structures, or sudden growth spurts. Muscle-related pain is generally localized to a single point, produces a sudden stabbing sensation, and becomes more intense with deep breathing. High-risk chest pain associated with the heart has an entirely different character; it generally presents as a heavy pressure in the chest during exercise, tightness that worsens with exertion, sweating, and shortness of breath. Distinguishing between these two types of pain is one of the most reassuring and informative parts of the diagnostic process.

Common complaints include:

  • Palpitations
  • Chest pain
  • Darkening of vision
  • Easy fatigue
  • Shortness of breath

Which Tests Are Performed for a Definitive Diagnosis When Mitral Valve Prolapse (MVP) Is Suspected?

The short clicking sound heard at the moment when the valve becomes tense while listening to the heart with a stethoscope, sometimes accompanied by a soft murmur, is the first important sign on this path. However, a definitive and final conclusion is not reached by listening to the heart alone; advanced and completely painless technological tests are used to clearly visualize the condition of the valve. The first and most valuable step in this process is echocardiography, which examines the heart using ultrasound. With the help of warm, water-based gel applied to the chest and harmless sound waves, the inside of the heart, its chambers, valve movement, degree of flexibility, and, if present, the volume of blood leaking backward are observed instantly and in color on the screen.

If the child frequently experiences palpitations, a portable rhythm recording device is attached to map and record the heart’s electrical activity throughout the day. The child goes home and to school with this small and lightweight device and continues normal daily life without interruption; in this way, any rhythm irregularities while sleeping, laughing, or running can be clearly identified. In older children and those involved in sports, an exercise test on a treadmill may be considered useful for observing how the heart responds during physical activity. When a much more detailed tissue examination is required, magnetic resonance imaging technology is used to map the process and determine whether there is any fatigue or structural strain in the heart muscle.

The methods used during the diagnostic process include:

  • Echocardiography (ECHO)
  • Electrocardiography (ECG)
  • Rhythm recording device
  • Exercise stress test
  • Magnetic resonance imaging (MRI)

What Is Mitral Annular Disjunction (MAD), Which May Occur Together with Mitral Valve Prolapse (MVP)?

One of the issues receiving close attention in recent years in cardiac health research is the anatomical harmony between the valve annulus and the lower muscular tissue of the heart. Sometimes a small separation or narrow gap measuring only a few millimeters may be detected between the circular annulus on which the valve sits and the heart muscle immediately below it. In medical terminology, this condition is called Mitral Annular Disjunction. If this distance exceeds a certain millimetric threshold on ultrasound measurements, the mechanics of heart movement are evaluated more carefully.

The primary importance of this microscopic separation originates from the physical effect it creates every time the heart contracts. This mismatch between the valve annulus and the underlying muscle may cause excessive contraction, asymmetrical pulling, and curling movements in the muscle tissue of that region while the heart pumps blood. This excessive pulling motion, repeated over months and years, may cause localized fatigue and structural micro-stress in the lower heart tissue. In response to this chronic stress, body tissue may gradually form small areas of scar tissue or hardening in that region. These small hardened areas may indirectly affect the pathways of the heart’s natural electrical flow, creating a predisposition to rhythm disorders later in life. Although this structural difference is quite rare during childhood, it is a valuable detail that should be monitored to preserve the long-term integrity and health of the heart.

The main factors monitored in this condition include:

  • Disjunction distance
  • Muscle curling
  • Tissue fatigue
  • Electrical conduction

What Is the Treatment Process and Sports Approach for Mitral Valve Prolapse (MVP) in Children?

The overwhelming majority of children diagnosed with valve flexibility live their entire lives without requiring any medication or surgical intervention. For these children, attending follow-up appointments at specific intervals is considered a sufficient precaution. However, if the sensation of palpitations makes daily life difficult, low-dose rhythm-regulating tablets or syrups may be used to gently calm the heart rhythm and reduce overall stress on the heart muscle. If valve flexibility causes significant blood leakage over time, medications that relax the blood vessels and balance blood pressure may be preferred to make it easier for the heart to pump blood throughout the body.

If the valve structure becomes completely unable to perform its function, valve repair may be considered. In repair procedures, the priority is always to preserve, repair, and strengthen the child’s own natural valve. Complete replacement of the valve with an artificial device is considered only in mandatory situations where other methods are insufficient.

Physical activity is a vital requirement for children to release their energy and support their psychological and physical development. Families often tend to restrict their children from sports, but regular exercise actually strengthens the heart. If there is no severe valve leakage, dangerous rhythm disorder, or history of unexplained fainting, children are not restricted from dynamic sports such as running, swimming, and gymnastics. They may only be advised to avoid heavy static sports that cause sudden and severe increases in pressure within the heart.

Activities that may be recommended for restriction include:

  • Heavy weightlifting
  • Shot put
  • Bodybuilding
  • Recommended types of sports include:
  • Swimming
  • Brisk walking
  • Cycling
  • Tennis

What Are the Methods of Preventing Infection in Children with Mitral Valve Prolapse (MVP)?

Infection of the thin membranes lining the inner surface of the heart or directly affecting the heart valve by certain bacteria entering the bloodstream may cause serious consequences for heart health. Valve flexibility and backward blood leakage may accelerate blood flow in that region and create an area susceptible to minor tissue damage. Millions of bacteria naturally live in our bodies, particularly in the mouth and gums. During procedures involving bleeding, such as tooth extraction, intensive dental scaling, or tonsil surgery, these bacteria may temporarily enter the bloodstream. When these unwanted guests reach the heart, they may attach to the stretched and irregular surfaces of the valve and attempt to initiate an infection.

The method of preventing this dangerous infection is quite simple and effective in modern medicine. Approximately one hour before high-risk dental or throat procedures, the child is given a single preventive dose of antibiotics appropriate for age and weight. This simple measure creates a powerful protective shield that immediately fights the bacteria when they enter the bloodstream. In addition to this medication, teaching the child to brush their teeth correctly and regularly every day is the strongest, most natural, and continuous defense method for preventing bacteria from passing from the gums into the bloodstream.

Why Is Regular Follow-Up So Important for Mitral Valve Prolapse (MVP)?

As children grow taller over time, their internal organs and heart structures also undergo continuous changes in parallel with this development. Valve flexibility that is very mild during infancy or early childhood may develop a different dynamic as the size of the heart changes during rapid growth spurts in adolescence. For this reason, even if the child appears to have no remaining complaints, professional evaluations at regular intervals are highly valuable for understanding the course of the condition.

During routine checkups, ultrasound examinations, rhythm monitoring, or exercise capacity measurements are repeated as needed according to the child’s current risk status and age. This follow-up plan is not designed to frighten parents with constant hospital visits; on the contrary, it is intended to keep the process fully under control, allowing children to participate safely in sports, focus on their education, and live for many years with a healthy heartbeat. This preventive approach, which compassionately accompanies the child’s growth process, makes it possible to detect even the smallest future problem at its earliest stage and resolve it calmly.

The main parameters monitored during follow-up include:

  • Heart chambers
  • Degree of flexibility
  • Rhythm stability
  • Exercise capacity
Güncellenme Tarihi: 13.10.2026

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