Mitral valve prolapse: New clinical and scientific insights in 2026.

Abstract

Mitral valve prolapse (MVP) is a prevalent valvular abnormality affecting 2-3% of the general population. MVP has two distinct anatomical subtypes: Barlow's disease and fibroelastic deficiency; each reflects different underlying structural and pathological processes. While most individuals generally remain asymptomatic with subclinical regurgitation, some develop significant mitral regurgitation followed by heart failure. A malignant form of MVP, marked by bileaflet prolapse, mitral annular disjunction (MAD), and myocardial fibrosis, is increasingly recognized as a substrate for ventricular arrhythmias and sudden cardiac death. In addition to transthoracic/transesophageal echocardiography, cardiac magnetic resonance is expected to contribute to risk stratification, particularly in identifying high-risk features such as MAD and fibrosis. As diagnostic capabilities continue to advance, integrating phenotypic, imaging, and electrophysiological insights will be key to optimizing outcomes in patients with MVP. This review provides a comprehensive overview of MVP, encompassing its epidemiology, molecular mechanisms, imaging evaluation, and current therapeutic strategies.