Mitral Valve

TNhe relation among the late systolic murmur, nonejection click, and prolapse of the mitral valve was established by Barlow and Pocock in 1963.1 In the past decade, 1,545 articles have discussed various aspects of this form of mitral regurgitation. How much this literature has added to our knowledge and to patient care is debatable. The pathology of the myxomatous mitral valve and related complications have been described with elegance and precision.2 4 Myxomatous replacement of the fibrosa weakens the involved mitral leaflet. Under the influence of left ventricular pressure, the leaflets and chordae become stretched -a process variously called "billowing," "ballooning," "prolapse," or "floppy" mitral valve but most often clinically referred to as mitral valve prolapse (MVP). Clinical observations have delineated the auscultatory characteristics of the nonejection click and the associated regurgitant murmur.5 Also, the electrocardiographic, cineangiographic, and echocardiographic findings in the typical case have been well documented.6-8 However, the waters have become muddied by reports associating the myxomatous mitral valve with various conditions, including sudden death and neuroendocrine disorders. These associations may be purely coincidental or a bias of sample selection. In particular, symptoms encountered among patients with the so-called "MVP syndrome" are more likely a result of psychogenically induced anxiety or comorbidity than neuroendocrine dysfunction. This point of view is elaborated on.