Question:
A 14-year-old adolescent is noted to have a mid-systolic click on cardiac auscultation. Regarding mitral valve prolapse in children, which of the following is true?
A 14-year-old adolescent is noted to have a mid-systolic click on cardiac auscultation. Regarding mitral valve prolapse in children, which of the following is true?
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MVP auscultation pearl: Standing Valsalva ($\downarrow$ preload $\rightarrow \downarrow$ LV volume) moves the click earlier in systole. Squatting handgrip ($\uparrow$ preload/afterload) moves the click later in systole.
Updated On: Sep 3, 2026
- It increases in prevalence with age
- It is commonly due to septal leaflet elongation
- It always causes significant MR
- It is more common in hypertensive children
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The Correct Option is A
Solution and Explanation
Concept:
Mitral valve prolapse (MVP), or Barlow syndrome, is characterized by superior displacement of abnormally thickened, redundant mitral valve leaflets into the left atrium during ventricular systole.
It is the most common valvular abnormality in adolescents and young adults and is frequently associated with heritable connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome.
Explanation:
• MVP is rare in infants and young children; its prevalence steadily increases with age throughout adolescence and into adulthood as myxomatous degenerative changes in the valve leaflets progress over time.
• Pathophysiologically, MVP is characterized by myxomatous expansion of the spongiosa layer with accumulation of glycosaminoglycans and disruption of collagen bundles, predominantly involving the posterior mitral leaflet (or both leaflets), rather than isolated septal/anterior elongation.
• Most pediatric and adolescent patients with MVP are entirely asymptomatic and have mild or no mitral regurgitation; significant MR is uncommon in childhood.
• The classic auscultatory finding is a non-ejection mid-to-late systolic click, often followed by a high-pitched late systolic murmur if mitral regurgitation is present. Maneuvers that decrease LV volume (such as standing or Valsalva) cause the click and murmur to occur earlier in systole.
Final Answer:
Mitral valve prolapse exhibits an age-dependent increase in prevalence, becoming significantly more evident during late childhood and adolescence.
Mitral valve prolapse (MVP), or Barlow syndrome, is characterized by superior displacement of abnormally thickened, redundant mitral valve leaflets into the left atrium during ventricular systole.
It is the most common valvular abnormality in adolescents and young adults and is frequently associated with heritable connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome.
Explanation:
• MVP is rare in infants and young children; its prevalence steadily increases with age throughout adolescence and into adulthood as myxomatous degenerative changes in the valve leaflets progress over time.
• Pathophysiologically, MVP is characterized by myxomatous expansion of the spongiosa layer with accumulation of glycosaminoglycans and disruption of collagen bundles, predominantly involving the posterior mitral leaflet (or both leaflets), rather than isolated septal/anterior elongation.
• Most pediatric and adolescent patients with MVP are entirely asymptomatic and have mild or no mitral regurgitation; significant MR is uncommon in childhood.
• The classic auscultatory finding is a non-ejection mid-to-late systolic click, often followed by a high-pitched late systolic murmur if mitral regurgitation is present. Maneuvers that decrease LV volume (such as standing or Valsalva) cause the click and murmur to occur earlier in systole.
Final Answer:
Mitral valve prolapse exhibits an age-dependent increase in prevalence, becoming significantly more evident during late childhood and adolescence.
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