heart association recommended prescribing antibiotics before invasive procedures, including those in dental surgery. thereafter, they concluded that "prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis." many organisms responsible for endocarditis are slow-growing and may not be easily identified on routine blood cultures (these fastidious organisms require special culture media to grow). these include the hacek organisms, which are part of the normal oropharyngeal flora and are responsible for perhaps 5 to 10% of infective endocarditis affecting native valves. it is important when considering endocarditis to keep these organisms in mind. prognosis generally, mvp is benign. however, mvp patients with a murmur, not just an isolated click, have an increased mortality rate of 15-20%. the major predictors of mortality are the severity of mitral regurgitation and reduction in ejection fraction. close monitoring and treatment, if necessary, is recommended for those with severe mvp to prevent complications and reduce the risk of mortality. in most cases, individuals with mvp can lead a normal and healthy life with minimal symptoms. prophylaxis the consensus is that mitral valve prolapse is a non-preventable condition, although some of its complications may occur. because symptoms rarely appear, the productivity of the patient's life is not affected. the worsening of the disorder can be delayed by avoiding smoking, the use of contraceptives (because they have the risk of clotting) and regulating the amount and type of exercise and nutrition under the supervision of a health professional. the risk of infective endocarditis is considered high in patients with prosthetic heart valves, moderate in those with mitral prolapse concomitant with mitral regurgitation and low in patients with mitral prolapse without other valve disease. antibiotic prophylaxis those with mitral prolapse are at increased risk of infective endocarditis, a bacterial infection of the heart tissue, as a result of certain routine non-sterile procedures, such as brushing the teeth. however, in april 2007, a study by the american heart association had determined that the risks of prescribing antibiotics outweigh the prophylactic antibiotics before invasive surgery, such as dental surgery or biopsy by colonoscopy or bronchoscopy. epidemiology prior to the strict criteria for the diagnosis of mitral valve prolapse, as described above, the incidence of mitral valve prolapse in the general population varied greatly. some studies estimated the incidence of mitral valve prolapse at 5 to 15 percent or even higher. one 1985 study suggested mvp in up to 35% of healthy teenagers. recent elucidation of mitral valve anatomy and the development of three-dimensional echocardiography have resulted in improved diagnostic criteria, and the true prevalence of mvp based on these criteria is estimated at 2-3%. as a part of the framingham heart study, for example, the prevalence of mitral valve prolapse in framingham, ma was estimated at 2.4%. there was a near-even split between classic and nonclassic mvp, with no significant age or sex discrimination. mvp is observed in 7% of autopsies in the united states. in a taiwanese chief heart study of asian adult military personnel, it was estimated that out of 2442 people in hualien aged 18 to 39, mitral valve prolapse occurred in 3.36%. people with mvp had lower body mass index, somatic symptoms related to exercise (chest pain, dyspnea, palpitations during exercise) and systolic click in auscultation. 7 out of 82 participants with mvp had mild pectus excavatum. research in a human and mice study of mvp, a relationship was found between mvp and progressive fibrosis effects on left ventricular structure, which suggests the cause of molecular and cellular changes are a response of papillary and inferobasal myocardium to increased chordal tension from prolapsing mitral valve leaflets. in animals in 2019 an experimental adeno-associated virus (aav)-based gene therapy method developed by rejuvenate bio, a biotechnology company. the method was successfully and effectively used on mice to reverse multiple age-related diseases: heart failure, kidney failure, type 2 diabetes and obesity. the study found that mice experienced a 58% increase in heart function and 75% reduction in kidney degeneration. rejuvenate bio later collaborated with tufts university to use the same method on cavalier king charles spaniel to stop the progression of mitral valve disease by stopping the accumulation of scar tissue in the heart. the therapy used a virus to deliver a genetic therapy that blocks the action of a specific protein that contributes to the accumulation of scar tissue. history the term mitral valve prolapse was coined by j. michael criley in 1966 and gained acceptance over the other descriptor of "billowing" of the mitral valve, as described by john brereton barlow.