Mitral valve prolapse.

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Abstract
For half a century the systolic click and late systolic murmur [in humans] lay dormant as innocent auscultatory curiosities. The 13 yr since Barlow related these phenomena to mitral leaflet prolapse have witnessed an astonishing information explosion. An Historical Perspective traces the evolution from the now abandoned 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, angiocardiography, echocardiography and physical and pharmacological interventions. Clinical Manifestations are concerned with prevalence, natural history, symptoms, physical signs, ECG abnormalities and roentgen findings. The 4 Major Complications, sudden death, infective endocarditis, spontaneous rupture of chordae tendineae and progressive mitral regurgitation, are examined. Associated Cardiac Diseases, i.e., Marfan''s syndrome, ostium secundum atrial septal defect and atherosclerotic coronary artery disease, are discussed, and a section on Treatment deals chiefly with prophylaxis for infective endocarditis and the management of arrhythmias and chest pain. A final section on Evolving Information considers etiologic concepts, the nature of left ventricular contraction abnormalities, the cause of chest pain, the relationship to Marfan''s syndrome and ostium secundum atrial septal defect and the effect of aging and sex differences on leaflet-chordal redundancy.