Which of the following is the most appropriate next step in management for an adolescent with isolated mitral valve prolapse and no mitral regurgitation on echocardiography?

• A. Referral to a cardiologist for further evaluation
• B. Repeat echocardiography annually for three years
• C. Reassurance and clearance for sports participation
• D. Surgical consult for valve repair

Answer: (C)

Isolated mitral valve prolapse in an adolescent who has no mitral regurgitation on echocardiography is typically a benign finding. The most appropriate next step is reassurance and clearance for sports participation. Without MR, there is no hemodynamic burden or risk of heart failure, so no urgent cardiology workup, surgical consultation, or routine invasive testing is needed. You would simply monitor clinically and allow normal activity, including sports, while staying alert for any new symptoms (chest pain, syncope, dyspnea, palpitations) or a new murmur. If those arise or if MR develops on follow-up, then re-evaluate with targeted testing and specialty input. Routine serial echocardiography is not required in an asymptomatic patient with stable MVP and no MR.