Treating with meds vs surgery

An echo done early this year shows significantly improved numbers from one two years earlier. EF jumped from 66% to 74%, and LVID dropped from 58mm to 53mm. (The echo report defines the normal range as 37 - 53mm.) MVR was described as moderate in both echos, although the latest one says it may be higher due to an "excentric jet directed anteriorly."

I was put on Lisinopril about 4 months before the latest echo, which I suspect accounts for the impoved numbers. I'm 61, in good health, no symptoms other than shortness of breath, but only on stooping to tie shoes or climb a hill. No problem with one flight of stairs.

Given the improved numbers, is postponing valve repair/replacement for a year or two a reasonable option, or do the risks of the valve deteriorating and other problems arising make early surgery preferrable?

[CCF-M.D.-RCJ]

Thumperguy,

Thanks for the post.  You may wish to visit the ACC site I've listed below.  I've pulled an excerpt below.

http://www.acc.org/clinical/guidelines/valvular/dirIndex.htm
"In the asymptomatic patient with chronic MR, there is no generally accepted medical therapy. Although intuitively the use of vasodilators may appear to be logical for the same reasons that they are effective in acute MR and chronic AR, there are no large long-term studies to indicate that they are beneficial. Furthermore, because MR with normal ejection fraction is a disease in which afterload is not increased (155,405,414,415), drugs that reduce afterload might produce a physiological state of chronic low afterload with which there is very little experience. However, in patients with MR resulting from increased preload (ie, CAD or dilated cardiomyopathy), there is reason to believe that preload reduction may be beneficial (223), and in a small series of patients with chronic MR in NYHA functional Class I to III, 1 year of quinapril therapy reduced LV volumes and mass and improved functional class (416). These data do not appear to be applicable to asymptomatic patients. Thus, in the absence of systemic hypertension, there is no known indication for the use of vasodilating drugs in asymptomatic patients with preserved LV function.

In patients with MR who develop symptoms but have preserved LV function, surgery is the most appropriate therapy."

Given that you have symptoms, albeit minor, you should at least be evaluated at a large center for consideration of surgery.  Patients who go into the surgery in better shape, usually come out of surgery in better shape.

Hope that helps.