Severe Mitral Regurgitation

[GEBster]

I have been diagnosed with 4+ severve mitral regurgitation.  One cardoiologist told me that since I have hypertension  Blood pressure averages are 150/99. Once under control with medications the reguritation should lessen and I should not have to worry.  I saw another cardiovascular surgeon and he told me even with the decrease in blood pressure I will still have some reguritation.  Cardiac cath done EF% 50% 4+ regruitation. Aortic Pressure 132/93, left vent pressure 132/5-10 cardiac output 8.9   My Cardiovascular surgeon based on these results still reccommends repair of mitral valve.  What are any commments or suggestions.?  Should I go with the reccommedations of the second doctor?

[smp48]

Is there any standard timing for repairng or replaceing the mitral valve? Does there have to be heart damage first? Would they do mitral or tricuspid surgery on someone with history of rheumatic fever, and also CAD with 50% blockage and high BP? What if the person is symptomatic with chest pain and fatique and the MR is still mild but left atrium is enlarged?

[msmerlin]

I thank the Doctor for clarifying on this. It is a fantastic tip for many with MR to know. My own cardiologist told me when she was informing me that I am going to have to have mitral surgery that "we can push it off longer if we can keep your BP down" and I really did not know that meant a lower BP will cause it to have less MR. I have mild myxomatous degeneration of both my leaflets with mild - moderate 2+  MR so I am hoping this tip will work for me. It is not going to be exactly easy for the next year to keep the BP stable for me becaue my former - shall I say - not so bright Cardiologist decided to maintain me on Rythmol for the past 15 years so now that I know that was inappropriate I am detoxing off it and it is a tretcherous situation especially with BP. I believe I was fortunate to find a new Cardiologist willing to even take on that task. I can't imagine a circumstance of a patient being on Rythmol and having to have mitral surgery.

[LacyMary]

Yes, this was interesting that CC doctor came back on and clarified things.  I have "some" Mitral regurgitation and the last Echo showed LVOT Obstruction due to SAM. (nest to Mitral Valve)  They are trying to get the BP down in the 110/70 range and HR in the 60 range in hopes this regime will help.

[Momto3]

WOW!!  That's so intersting.  Thanks for clarifying the b/p matter...I'll be interested to see if it changes my regurgitation over a greater period of time. I do recall my EP telling me that optimal b/p control is important with a leaky valve.

Have a great day and thanks again!  Always learning something new here : )

Connie

[CCF-M.D.-MJM]

I think this is an important question and just want to comment on a few of the posts.

1. The higher your systemic blood pressure, the higher the pressure in your left ventricle.  If you blood pressure is 150/60, odds are your left ventricular blood pressure is 150 systolic as well.  Your atrial pressure is probobably around 10 or so.  

The difference between your ventricular pressure and atrial pressure is the pressure driving blood back into your left atrium.

150-10 = 140
100-10=90

the lower the pressure driving the regurgitation, the less regurgitation there will be.

2. The Cleveland Clinic and several other hospitals around the country ( I believe Mayo approaches this problem the same) will sometimes operate on people without symptoms to prevent negative remodeling of the left ventricle (just like tkl mentioned above).  Not every hospital does this yet.  Opinions about the right time to do a mitral repair / replacement vary around the country.

3. We do our best to do a mitral repair over a replacement if possible -- it is more physiologic.  We have extensive experience in mitral valve repairs.  If you are close to Cleveland and want a second opinion, we would love to see.

Good luck.

[Dynomite]

I have moderately severe regurg ranges from -3to+4.  I have low mormal bp 110to 120 over 60 to 70.  I never heard that lowering high bp would help the regurg.  If this was true I would have no regurg.  If you have SOB or your left ventricle is enlarged it would be time to operate.  The majority of Mitral Valve operation at Cleveland are repairs.  This is not true at many other hospitals

[TL]

Please do not wait for symptoms.  I was in your same situation with no symptoms and opted for surgery based on my cardiologists recommendation.  After the surgery the surgeon commented that is was good that I did not wait any longer.  If you truely have severe regurgitation, the earlier you get surgery the better.  If you wait until you experience symptoms it could be too late for the surgery to help.  Permanent damage may have been done.  Some studies have indicated that you have a 50% chance of dying within 5 years and an 80% chance within 10 years. If you get a repair you life expectancy is almost the same as someone without any heart issues.  I would go to the Cleveland clinic or another major heart hospital and get a second opinion and find a doctor who specializes in mitral valve repair.  Your EF of 50% indicates that your heart may be starting to compensate for the leakage.  The key is to get the surgery before it decompensates.

[Momto3]

I am not a doctor, but.....it would be news to me if regurg were to lessen as a result of lowering b/p.  I have moderately severe mitral valve regurg and am taking lisinopril for optimal b/p control.  No change in the regurg, but b/p is much better.  HOORAY!!  When it was suspected that I had severe (4+) regurg, I was directed to the Cleveland Clinic for consideration of valve repair.  A TEE was performed and it turned out that I did not have severe regurg = no surgery. My last echo still showed mod. severe regurg, essentially no change.

Also, a big indication for surgery is when you experience symptoms.  Have you had any shortness of breath or other symptoms associated with your leaky valve?

[CCF-M.D.-MJM]

Hello Gebster,

Very important question.  It is true that reducing blood pressure should decrease the amount of MR. It is tricky to second guess teh judgement of another physician when they have actually seen the test results.  You will probably find many different opinions on this matter as it is an area of changing opinions.

If the recommendation is against surgery at this time, I would consider obtaining a second opinion from a cardiologist.  Your surgeon may be right, but I would ask another cardiologist to look at the data and render another opinion.

Good luck