mitral valve regurg and pulmonary hypertension

[Elizabeth__0__0]

  Because I am training for a marathon, had taken phen fen, and have known I
  had a heart murmur for 15 years I've recently had an EKG and echo. The EKG
  was normal but the echo identified mitral valve regurg, pulmonary pressure
  of 69 and mild enlargement of the right side of my heart. Because of the
  phen fen connection, I'm terribly afraid its PPH.
  On the other hand I know PPH is very rare even for those who have taken phen
  fen. I have no symptoms. In fact the marathon training is complete and
  I've run 18 miles and 3.5 hours easily (notice I didn't say fast!) twice
  recently.
  What are the possibilities and probabilities here? Could this this mitral
  valve problem be of long standing and have caused this pulmonary hypertension?
  How can I be asymptomic with pulmonary pressure of 69?
  Any info or insight appreciated.

[CCF CARDIO MD APS]

Dear Elizabeth,  I write back to you if only to tell you that that elevated pulmonary artery pressure is very concerning and yes it could be the result of a longstanding mitral valve problem as opposed to the Phen-phen. Regardless you need to seek further evaluation and treatment as soon as possible since it has become very clear to many of us in cardiology (both surgeons and cardiologists) that the time to fix a deranged mitral valve is BEFORE the patient develops symptoms.  The guage for when to operate therefore is things like elevated pulmonary artery pressures.  It is imperative that you see a cardiologist if you have not already who can evaluate that pulmonary hypertension further (usually with a right heart catheterization) in order to assess for the true level, it's reversibility and to set a schedule for if and when you might need surgical repair and or replacement of the mitral valve.  Keep in mind that the mitral valve problem itself may be due to the phen-phen.
We do fully understand how a person with such a high pulmonary pressure can be asymptomatic but we do unfortunately know of the series complications that can occur (threat to lifestyle and life itself) if the disease process is progressive and goes untreated.
Information provided in the Heart Forum is intended for general informational purposes only, any diagnosis and treatment can only be made by your physician(s).  If you are interested in care at the Cleveland Clinic Foundation just call 1-800-CCF-CARE and ask for any of the doctors who treat heart failure and pulmonary hypertension at desk F25.