SPECIAL ARTICLE Mitral Valve Prolapse

SUMMARY For half a century the systolic click and late systolic murmur lay dormant as innocent auscultatory curiosities. The thir-teen years since Barlow related these phenomena to mitral leaflet prolapse have witnessed an astonishing information explosion. We have sought to bring together the accumulated data in this review. An Historical Perspective traces the evolution from the now aban-doned "pericardial " or "extracardiac " phase, through the leaflet-chordal phase (redundancy), the myocardial phase (segmental left ventricular contraction abnormalities), to the anular phase (dilatation and faulty systolic contraction). Functional Anatomy is dealt with in terms of pathology, pathophysiology, hemodynamics, angiocardiog-raphy, echocardiography, and physical and pharmacological inter-ventions. Clinical Manifestations are concerned with prevalence, IN 1963 Barlow published angiographic evidence that sys-tolic clicks and late systolic murmurs were associated with prolapse of the posterior mitral leaflet. Subsequent studies gradually established the protean manifestations of mitral valve prolapse, and more recent investigations have provided a virtual cornucopia of related information. The need now exists to assemble this information into a single coherent es-say. We have sought to do so in this review under the follow