after mutral valve surgery

I had mitral valve repair 3 years ago.After a visit a few months ago to my doctor,he told me my leakage had gone from very mild back to mild to moderate.A TEE was done and i was told no surgery was needed at this time.I was put on lisinipril,,10 mg a day,,atenolol,,12.5 mg twice a day.He told me my blood pressure may have crept up over the last year causing the leakage.It had been stressful following the death of my son due to a cardiomyopathy and a divorce.My question is,is this common,do you actually know why the leakage may have occured and will the medication be able to shrink my heart and keep the leakage under control?Also,,what are some key questions i should be asking my doctor? Thank you again for you help. Lou Bell

[CCF-M.D.-CRC]

Dear Lou,

My condolences on the difficult last 3 years you have had.  The last thing you need right now is more heart trouble.  However, the good news is that it dosen't appear anything needs to be done right away.  Mitral valve repairs will sometimes deteriorate over time eventually requiring valve replacement.  Usually this is not necessary until the leakage is severe and/or there are symptoms of fatigue, shortness of breath or swelling or if the heart function is noticed to be decreasing on echocardiogram.  Medications can help prevent progression. The deterioration is due to the natural history of the disease and not due to increased stress.  I would recommend having an echocardiogram at least every year and possibly every 6 months depending on the circumstances.  Good luck.