15.1
Prolapsus de la Valve Mitrale I : Introduction
Introduction
La valve mitrale, l'une des quatre valves cardiaques, régule le flux sanguin. Ces valves possèdent des clapets qui s'ouvrent et se fermen…
Le prolapsus de la valve mitrale, ou MVP, est une maladie cardiaque dans laquelle des anomalies des feuillets de la valve mitrale, des muscles papillaires ou des cordes tendineuses permettent aux feuillets de prolapsus ou de se replier dans l’oreillette gauche pendant la systole.
Le MVP peut découler de divers facteurs.
Les altérations structurelles de la valve mitrale dues à la dégénérescence myxomateuse sont fréquentes.
Des facteurs génétiques liés à des troubles du tissu conjonctif comme le syndrome de Marfan y contribuent également.
D’autres causes comprennent des malformations congénitales, des changements dégénératifs liés à l’âge et des affections squelettiques comme la scoliose ou la dystrophie musculaire.
La pathogenèse de la MVP commence par l’épaississement des clapets valvulaires en raison d’un excès de collagène et de protéoglycanes, ce qui les rend souples et sujets au prolapsus.
Pendant la phase de contraction du cœur ou systole, les volets valvulaires élargis peuvent se renfler vers l’arrière dans l’oreillette gauche, entraînant une fermeture anormale de la valve.
Les cordes tendineuses, qui relient les volets valvulaires aux muscles papillaires du cœur, peuvent s’affaiblir, altérant davantage la fonction valvulaire.
Il en résulte une régurgitation mitrale, où le sang retourne dans l’oreillette gauche pendant la systole, entraînant des complications telles que la fibrillation auriculaire, l’hypertension pulmonaire et l’insuffisance cardiaque.
View the full transcript and gain access to JoVE Core videos
Q1: What happens to the mitral valve during mitral valve prolapse?
During mitral valve prolapse, the mitral valve leaflets abnormally bulge backward into the left atrium during systole, the heart's contraction phase. This occurs when the valve leaflets become thickened and enlarged due to myxomatous degeneration, making them floppy and prone to prolapse. The weakened chordae tendineae, which anchor the leaflets to papillary muscles, further impair proper valve closure.
Q2: What structural changes cause mitral valve prolapse?
Mitral valve prolapse results from thickening of valve leaflets due to excess collagen and proteoglycans, a process called myxomatous degeneration. This abnormal tissue accumulation makes the leaflets spongy and enlarged. Additionally, alterations in the chordae tendineae weaken the cords anchoring the valve to the heart muscle, compromising the valve's ability to close properly during systole.
Q3: How does genetic predisposition contribute to mitral valve prolapse?
Genetic factors play a significant role in mitral valve prolapse development. The condition is often inherited and commonly associated with connective tissue disorders like Marfan syndrome, Ehlers-Danlos syndrome, and osteogenesis imperfecta. These inherited disorders affect the body's connective tissues, leading to structural abnormalities in the mitral valve that predispose individuals to prolapse.
Q4: What complications can result from mitral valve prolapse?
Mitral valve prolapse can lead to mitral regurgitation, where blood rushes backward into the left atrium during systole. This causes volume overload in the left atrium and may result in left atrial and left ventricular enlargement. Significant mitral regurgitation can trigger serious complications including atrial fibrillation, pulmonary hypertension, and heart failure.
Q5: What non-genetic factors contribute to mitral valve prolapse development?
Beyond genetic factors, mitral valve prolapse can develop from congenital malformations, age-related degenerative changes in valve leaflets, and skeletal conditions like scoliosis, chest wall deformities, and muscular dystrophies. Developmental abnormalities occurring during the fetal stage may also predispose individuals to MVP. Additionally, evidence suggests higher prevalence in women, though the reasons remain unclear.
Q6: How does the mitral valve normally function in the heart?
The mitral valve regulates blood flow from the heart's upper left chamber (left atrium) to the lower left chamber (left ventricle). During each heartbeat, the valve opens to allow blood passage and closes securely as the ventricle contracts to pump blood to the body. This prevents backflow and ensures unidirectional blood circulation through the heart.
Q7: What role do papillary muscles and chordae tendineae play in mitral valve function?
The chordae tendineae are cords that anchor the mitral valve leaflets to the papillary muscles, specialized heart muscle structures. Together, they stabilize the valve leaflets and ensure proper closure during systole. When these structures weaken or become altered, the valve leaflets cannot close smoothly, increasing the likelihood of prolapse and valve dysfunction.