Cardiovascular Disease: Valvular Heart Disease

Mitral Valve Prolapse

LEOs undergoing initial evaluation for mitral valve prolapse can be cleared for full duty if they meet all of the following criteria: 

• Asymptomatic (e.g., no symptoms of reduced cardiac output, no signs of arterial emboli, etc.) 
• No history of syncope of arrhythmogenic origin 
• Recent (within past 12 months) ECG with normal sinus rhythm, no arrhythmias, no T wave inversion, and no QT prolongation7 
• Recent (within the past 12 months) EST to at least 12 METS showing normal findings 
• Recent (within the past 12 months) ambulatory Holter monitor (at least 24-hours) showing no arrhythmias 
• Recent (within the past 12 months) echocardiogram showing: 
  • Normal left ventricular ejection fraction (LVEF) 
  • No mitral valve regurgitation 
  • No left atrial dilatation7,8 
  • No mitral annular disjunction7,9 

Follow-up Evaluation for Mitral Valve Prolapse: LEOs with mitral valve prolapse should have an annual evaluation by a cardiologist or other physician knowledgeable in the treatment of cardiac valvular disease. Serial echocardiograms are indicated with clinical evidence of severe or worsening mitral regurgitation,10 or every 3-5 years.11 Results of both the baseline evaluations and the echocardiograms should be shared with the agency’s medical provider. 

Mitral Valve Repair or Replacement Surgery: See the last section of this chapter.