Is surgery the right option?

I am a 45 year old male and was diagnosed with a mitral valve prolapse 25 years ago.  Recent echocardiograms show moderate to severe regurgitation and moderate enlargement of the left atrium, but my ventricular function is good and I have remained active and symptom free until recently.

About three months ago, I started experiencing bouts of atrial fibrillation several times a day that lasted for up to several hours.   My cardiologist put me on Coumadin to prevent clots, and tried drugs to fix the arrhythmia.  After several partial successes which reduced the frequency and severity of the fibrillation, but didn't quite stop it, we tried Rhythmol, and the fibrillation stopped.   At the same time the Rhythmol was prescribed, she recommended that I consult a surgeon to see about getting my mitral valve fixed.

My question is:  if the fibrillation has been stopped, is the surgery still something I should be considering?   Will the problem keep getting worse without surgery, or could the use of beta blockers or other drugs reduce the load on my mitral valve, reduce the rate of regurgitation, and lead to a reversal of the atrial enlargment?   What are the relative risks of surgery as oppossed to continued medical approaches?   If surgery is the right thing to do, then I'll do it, but I don't want to put myself and my family through that trauma if it is not warranted.

I know that this is a case-by-case decision, but I would like to know if there is any sense in trying to avoid surgery, and whether my thinking is sound.

Thanks,

-- Steve

[CCF-M.D.-KE]

Dear SIR,

Sorry to hear about your valve disorder.
You have been diagnosed with severe mitral regurgitation related to MVP and recently have been experiencing atrial fibrillation.
These findings suggest that you need to be evaluated for surgery. I would recommend a surgical evaluation at a large university based medical center. You may be a candidate for mitral valve repair and may not need a mitral valve replacement. Here at the Cleveland Clinic Foundation we have experts in this area. I would recommend visiting our website at www.ccf.org or calling 1-800-CCF-CARE to schedule an appointment with a cardiologist. If the Cleveland Clinic Foundation is not an option for you, visit a local university based medical center and ask about a mitral valve repair.
Keep us posted.

Thanks for your question,


CCF-MD-KE

[catmom523]

I truly wish I'd had your choices.  I also had mvp for nearly 25 years.  I ended up with a mitral valve so badly damaged that the repair didn't work and I had to have a mechanical; a damaged tricuspid (repaired; and the damage was due to the mitral valve); and an enlarged ventricle.  Surgery certainly wasn't optional, and now I'm waiting to see if the heart will recover.

From my point of view, you should go for the surgery, and certainly want a mitral valve repair.  Get evaluated and don't delay.  You really don't want to sample congestive heart failure and multiple valve problems.

This is a very difficult decision to make at your age - particularly when you're feeling good.  You'll have to be extremely brave to have the surgery.  I suggest you visit valvereplacement.com for the layman's view of valve surgery.  I think you'd find it as informative and interesting as I do.

[BillC]

I had my MV repaired at the Cleveland Clinic about 1.5 years ago at age 44. I'd recommend you do it before your heart suffers irreversible damage.  I am pleased w/ my own outcome - able to cycle and do triathlon, w/ no adverse effects.