Timing of Mitral Valve Repair Surgery/New Study on asymptomatic patients

[barry70]

Hello and thanks for taking my question.   After Dr. Enriquez-Sarano's new study came out a few weeks ago, I was encouraged to get a new echo to get measurements as per that study.  After all, I am asymptomatic, 35 year old male, with MVP and almost severe MR.  I seemed to be the exact kind of person this study was speaking of.  My meausrements were as follows:

.37 cm2 ERO by the flow convergence method.

Prominent late systolic billowing if both leaflets consistent with MVP.

3-4+ (near severe MR) mid-late systolic MR.

1+ Tricuspid Regrurg.

Mildly dilated Aortic Root (4.2)

LA = 3.5

EF = 60%

LVIDd= 5.5
LVIDs = 3.7

Trileaflet Arotic Valve

All else is normal - normal estimated pulmonary artery systolic pressure too.


I seem to be pretty close to the magic 40 number for the ERO from the article, although my heart size seems good for now.   Via email and only having only the same info I am sharing here, Dr. Sarano said I was "not so bad" and I should be revaluated in a year.   To me, .37cm2 seems really close to .40 cm2.  About how long will it take to go 3 more square millimeters to where surgery will be more pressing (if there is even an answer to that)?  I know that surgery is in my future, my the when part is still at issue.  Many thanks again!

[Emmaj]

Hi Barry,

Have you had a TEE or a cardiac cath? I actually needed a cath before the doctors made up their minds it was time for my mitral valve surgery. Also, you might want to check out this website: www.valvereplacement.com. A lot of information and support to be found there. Beat of luck!

[Cleveland Clinic]

barry,

Thanks for the post.  

Timing of mitral surgery is a often debated topic especially in asymptomatic patients.  No matter what method of evaluation you use in a patient without symptoms or signs of cardiac damage, is to repair before any irreversible damage occurs.  

The real key to accomplish this is close follow up.  If your ERO is .37 and there are other signs on the echo or symptoms of mitral regurgitation that the mitral regurgitation is worse, then its worth fixing the valve even with an ERO of under 0.4.  If there are signs that the MR is better then the ERO and no symptoms then waiting may be a better option.

This is really why its very important to have your evaluation with a cardiologist/surgeon combination that is very experienced with valvular disease and repair.

good luck