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Floppy Valve Syndrome

Mitral valve prolapse is a valvular heart disease which results from the systolic movement of abnormally thickened mitral valve leaflets into left atrium during left ventricular systole. MVP refers to expansion of area of mitral valve leaflets with elongated chordae tendineae or rupture of chordae and mitral annular dilation. Rupture of chordae may be associated with heritable syndromes of connective tissue disorders. It usually inherited either through the autosomal dominant gene or chromosome X, which is less common compared to the former. MVP may lead to either progressive MVR or stimulate autonomic nervous system or neurohumoral activation. The former is termed as MVP and later is termed as “Floppy valve syndrome”. Symptoms of FVS include palpitations, dyspnea, chest pain, and neuropsychiatry symptom. Complications of FMV include infective endocarditis, Thromboembolic complications, systolic arterial hypertension, cardiac arrhythmias or cardiac death. Initially pharmacological agents are used as first line therapy. When severe mitral regurgitation is present in asymptomatic patient with FMV/MVP surgical intervention such as valve repair or valve replacement is recommended.


INTRODUCTION
"MITRAL VALVE SYNDROME" [MVP] is also known as, "Floppy mitral valve syndrome", "Click murmur syndrome", "Billowing mitral leaflet" or "Barlow syndrome". MVP is a valvular heart disease results from the systolic movement of portion(s) or segments of mitral valve leaflets into left atrium during left ventricular systole. The term FMV(Floppy mitral valve) comes from surgical and pathologic studies and refers to expansion of area of mitral valve leaflets with elongated chordae tendineae, chordae tendineae rupture and often mitral annular dilation.

Inheritance:
It is transmitted by two forms of inheritance: Autosomal dominant inheritance, which is the most common type. At present 3 gene loci have been reported.
Chromosome X, which is rarely seen.

Classification:
• FMV/MVP occurs in heterogeneous group of patients with wide spectrum of mitral valve involvement and hemodynamic abnormalities from mild to severe. Mitral valves with diffuse thickening are referred to as "Barlow's valve", while patients with regional thickening of mitral valve are referred to as a "Fibroelastic deficiency valve". Two types of symptoms can be defined in FMV/MVP patients. Based on these symptoms it is classified into FMV/MVP/MVR and FMV/MVP syndrome. In one group of patients, symptoms, physical findings and natural history are directly related to progressive mitral regurgitation and its complications through their effects on left ventricular structure and function, and pulmonary circulation. In the other group of patients, symptoms cannot be explained by degree of MVR alone, activation of the autonomic nervous system or neuroendocrine dysfunction has been implicated for explanation of the symptoms in this group of patients. This group is referred to as the "FMV/MVR SYNDROME".
• Based on leaflet thickness, type of connection to the mitral annulus, and concavity. Subtypes can be described as classic and non classic, symmetric and asymmetric, flail and non flail.

Classic and nonclassic:
Prolapse occurs when mitral valve leaflets are displaced more than 2mm above the mitral annulus high points. The condition can be further divided into classic and non classic subtypes: based on the thickness of mitral valve leaflets: upto 5mm is considered non classic; while beyond 5 mm is considered classic MVP.

Symmetric and asymmetric:
Classical prolapse may be subdivided into symmetric and asymmetric; referring to point at leaflet tips join the mitral annulus. In symmetric coaptation, leaflet tips meet at a common point on the annulus. Asymmetric coaptation is marked by one leaflet displaced toward the atrium with respect

Flail and non-flail:
Asymmetric prolapse is further subdivided into flail and non flail. Flail prolapse occurs when a leaflet tip turns outward, becoming concave toward the left atrium, causing the deterioration of the mitral valve. The severity of flail leaflet varies, ranging from tip eversion to chordal rupture.
Dissociation of leaflet and chordae tendineae provides for unrestricted motion of the leaflet. Thus, patients with flail leaflets have higher prevalence of mitral regurgitation than those with the nonflail subtype.

Signs and symptoms:
Most individuals with MVP have no symptoms and do not require treatment or close monitoring.
However, some individuals can be symptomatic and most common symptoms in these patients include: • Murmur: When the posterior leaflet prolapses, the murmur may radiate anteriorly along the left sternal border; when the anterior leaflet prolapses, the murmur may radiate to axilla and to spine. • Numbness or tingling in fingers or toes.

Risk factors:
• MVP occurs at equal rates in men and women. However, for the reasons not clear, men are with MVP are at higher risk of complications (such as infectious endocarditis, sudden cardiac death, heart attack, stroke or severe mitral regurgitation) than women.
• Certain connective tissues disorders also increase the risk of MVP such as: • Another risk factor of MVP is hypertrophic cardiomyopathy, which may cause the mitral valve leaflets to elongate or thicken. Scoliosis, some type of muscular dystrophy, polycystic kidney disease, and Grave's disease also increase the risk of MVP.
• Other risk factors include:

1.
Family history of floppy valve syndrome

3.
Low body weight

6.
A history of rheumatic fever  Antiarrhythmics help to control heart rhythm by normalizing electrical signals in heart tissue.

Aspirin:
Aspirin is recommended for:  Patients with history of recurrent cerebral transient ischemic attack.
 Patients younger than 65 years with atrial fibrillation and no history of hypertension, mitral regurgitation, or congestive heart failure.
 Post stroke patients with contraindications to warfarin.
 Patients in normal sinus rhythm with echocardiographic evidence of high risk mitral valve prolapse. The good news is that there is a whole array of "natural" therapies for people with mitral valve prolapse, which can help alleviate the multiple symptoms. They range from behavioral therapies to diet modifications and nutritional supplements.

COGNITIVE THERAPY:
This is the basic ground for the holistic approach to MVP. It's important for everyone with this condition to seek out a sympathetic or holistic physician who can clearly explain the variety of possible symptoms, confirm that they are not imaginings or hypochondriasis and provide a program L-carnitine is an amino acid that act as a shuttle for fat that is required for cellular metabolism. It can be used as a cellular equalizer and also acts to strengthen the heart.Dosage:500-1000 mg twothree times daily. Acetyl-l-carnitine is related nutrient that may be more bio available. Dosage : 120 mg three times Daily.
Coenzyme Q10 appears to improve disturbed bio energetic function at the molecular level.
Coenzyme Q10 enhances the pumping action of heart, output of blood, speed of heart muscle contraction and general cardiac efficiency. Dosage:60-120 mg/day.