How to manage an athlete with mitral valve prolapse

Introduction: Under the term degenerative mitral valve prolapse different pathophysiological and clinical entities coexist in a spectrum ranging from Barlow’s disease to fibroelastic deficiency, and represent the most common cause of mitral regurgitation in the general population and in athletes. Carrying a mitral valve prolapse is usually considered a benign condition for athletes, but recently the scientific literature has focused on the malignant, thus rare, arrhythmic mitral valve prolapse and its dramatic association with sudden cardiac death, so that specific features should be considered a red flag and prompt additional exams before clear for competition. Discussion: As the athlete’s heart is morphologically accompanied by remodelling and dilatation of the cardiac chambers induced by exercise, it may be challenging to differentiate the degree of left ventricular and atrial dilation induced by significant mitral regurgitation from physiological remodelling, especially in endurance athletes. Conclusion: This how-to article provides clinical and useful data to manage athletes with mitral valve prolapse and to distinguish high-risk athletes carrying the features of arrhythmic mitral valve prolapse.