Figure 50-24 Left, The dynamic spectrum, time in years, and progression of mitral valve prolapse (MVP) are shown. A subtle gradation (crosshatched area) exists between normal mitral valves and valves with mild MVP but without mitral regurgitation (no MR). Progression from the level MVP-no MR to another level may or may not occur. Most patients with MVP syndrome occupy the area above the dotted line, whereas those with progressive mitral valve dysfunction occupy the area below the dotted line. Right, The large circle represents the total number of patients with MVP. Patients with MVP may be symptomatic or asymptomatic. Symptoms may be directly related to mitral valve dysfunction (gray circle) or to autonomic dysfunction (red circle). Certain patients with symptoms directly related to mitral valve dysfunction may present with and continue to have symptoms secondary to autonomic dysfunction. (Redrawn from Boudoulas H, Wooley CF: Mitral Valve Prolapse and the Mitral Valve Prolapse Syndrome. Mt Kisco, NY, Futura Publishing, 1988.)