Mitral valve prolapse virtually diagnostic of MVP. The handgrip maneuver diminishes the murmur of an MVP and the murmur of hypertrophic cardiomyopathy. The handgrip maneuver also diminishes the duration of the murmur and delays the timing of the mid-systolic click. Both valsalva maneuver and standing decrease venous return to the heart thereby decreasing left ventricular diastolic filling (preload) and causing more laxity on the chordae tendineae. This allows the mitral valve to prolapse earlier in systole, leading to an earlier systolic click (i.e. closer to S), and a longer murmur. Historically, the term mitral valve prolapse syndrome has been applied to MVP associated
Mitral valve annuloplasty the native annulus and some of its natural dynamics. The goal of semi-rigid rings is to maintain coaptation and valve integrity during systole, while allowing for good hemodynamics during diastole. Rigid rings are designed to provide rigid support in large dilation and under high-pressure. Annuloplasty devices usually come in different sizes. The surgeon can estimate the dimensions of the patient’s mitral valve and decide on an appropriate ring size. Depending on the disease etiology, different approaches are taken. Surgeons can decide to "undersize" the device, "truesize" the device, or "oversize" it. Annuloplasty devices are classified by the U.S. Food and