Results of Nuclear Cardioangiogram?

  Hello, I am 29 years old, female and after three years of complaining to my GP of chest pains in the heart region and fatigue it was discovered that I have mild mitral valve prolapse but have severe regurgitation.  Can you please explain how someone with mild prolapse could have severe regurgitation - this I don't understand. This was discovered by an echo cardiogram. Recently I've had this nuclear cardioangiogram done abd my GP passed along these results over the tele - normal ejection fraction at rest however at stress ejection fraction is flat.  What does this mean?  As my GP didn''t know herself and is not avail. to get more info til next week.  I am in the process of looking for a new cardiologist because the last one I saw - the one that ordered this test - made me feel like all the symptoms I have, chest pains and fatigue etc. are not related.  I KNOW THEY ARE so I have to question her experience in this area.  She already advised me I will need a mitral valve repair at some point. I was really hoping later as I have small children (8 & 5).  Also she wanted to do another test, an echo but one that goes down your throat.
  I would really appreciate any comments you have as I am quite anxious about it all.  Thank you. Christina

[CCF CARDIO MD APS]

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Dear Christina,
Any degree of "prolapse" can alter the coaptation line of the mitral valve (i.e.
where the leaflets come together to form a closed valve) so as to cause severe
mitral regurgitation (MR).  The "mild" prolapse may simply be describing the
degree to which your valve falls back in to the left atrium (upper left chamber of the heart.)
Approximately 15% of those with "mild" mitral valve prolapse will go on to develop severe mitral
regurgitation later in life.  We do not fully understand why 15% do, nor why the other 85% do not.
A TEE (TransEsophageal Echocardiogram) is one where you look at the heart from the inside (specifically from the esophagus, your feeding tube that leads to your stomach.)
This type of echocardiogram is very low risk and provides a much clearer and better defined picture of the heart valves (because the ultrasound beams do not have the chest wall to go through before reaching the heart.)
This would be routinely done on a patient like you, especially if surgery were being considered.
A stress ejection that is "flat" probably means that your fatigue is due to the MR and you would best be served with surgery soon, NOT LATER>
When the ejection fraction fails to increase (remains flat) with exercise in a person with valve disease, this is a sign that the heart has done all that it can
to compensate for the MR, and actually is getting tired so to speak (untreated MR will lead to heart failure if surgery is not done at the appropriate time.)
Here at the Cleveland Clinic, our Chairman of Cardiothoracic Surgery, Dr.Cosgrove, is one of the pioneers of valve repair, where the valve is fixed, not replaced.  This is a major advance and fairly new so there are not many
surgeons in the country who are experienced as such.
At the very least, seek a cardiologist that specializes in valve disease, one that works closely with surgeons who are experienced at valve repair.  Just to give
you a reference, the Cleveland Clinic surgeons are close to 90% successful with valve repairs.
I hope this information is useful. Information provided in the heart forum is for
general purposes only. Only your physician can provided specific diagnoses and therapies.
Feel free to write back with further questions. Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please
call 1-800-CCF-CARE or inquire online by using the Heart Center website at
www.ccf.org/heartcenter. The Heart Center website contains a directory of the
cardiology staff that can be used to select the physician best suited to address your
cardiac problem.  Some of our valve cardiologists are Drs.Griffin, Garcia, Rodriquez, Isada, Mayer-Sabik.