tests diagnostic for mitral valve prolapse

[emma]

Hi CRC

I am 47 and had bypass surgery 20 years ago due to a benign tumor that was blocking my coronary arteries.  I had two catheterizations performed at that time by a doctor who only performed caths.  He was extremely kind to me and much more helpful than my cardiologist at that time in answering my questions.  I have always felt very indebted to him.  Now, 20 years later my cardiologist (new), who I also like and respect very much, became very distressed on seeing my echo and told me that I needed mitral valve surgery, that that the echo showed significant dilation of atrium and ventricle.  He ordered a cath to see whether my bypass grafts were in good shape.  I had the doctor I had first seen 20 years ago perform this cath.  He told me I did not need surgery, that my problem was moderate, and not to bother having a TEE(which he told me would be ordered next) and that catheterization was THE only test to pay attention to.  (I'm not sure he would be so frank with everyone about this, but we have known one another a long time at this point.) He also said my pressures (not sure what he meant) were good.  Sure enough, my cardiologist ordered a MUGA, TEE and a stress echo, and I did go ahead and have them. My ejection fraction is 64% and I did very well on the stress test, though it was followed up by SV tachycardia during the echo. (Arrthymia is my main symptom.) My cardiologist told me that my mvp was not the worst he's seen, but that it is severe and that I would need surgery in six to twelve months. Such surgery would be high risk for me, given my tumor involves my left atrium.  I had really hoped that the two doctors would reconcile their opinion as to the severity of my problem, but this never happened.  I am starting to think that the reason for this is really a more fundamental controversy in the field of cardiology as to just what tests are diagnostic for mvp.  Am I right? Do you have an opinion on this? I know that if my cardiologist tells me that "now is the time," I will go ahead and have the surgery, but I feel rather badly about this situation - I know this sounds crazy, but the main reason I feel bad is that I want to show my respect for both doctors' advice. Anyway, my cardiologist wants me next to see a specialist in diagnostic imaging, so I'm hoping to come out to CCF.  Thanks very much for your answer.  

[dkader]

Dear Emma,

I can understand how you must feel, not wanting to betray the other doctor's advice.  I had MVP repair at CCF in June 1999 and would highly recommend your coming here, either for evaluation or the surgery, or both.  I was just wondering what the degree of regurgitation was from your echo.  Mine was 4+.  I was having symptoms and had my surgery 4 months after being diagnosed.  I never realized I had been having minor symtoms for the past year until I had the surgery and all the symptoms went away.  I would love to talk to you, if you like.  This can all be quite scary even though you've already been through heart surgery before.  My email is ***@****.

Sincerely,
Denise

[CCF CARDIO MD - DLB]

Several different tests can provide information about MVP, including catheterization. Echo and TEE, if the images obtained are of good quality, are the best methods. Stress echo is also very useful to see if the amount of MVP increases with exercise. In the past, surgery was not recommended for valve leakage, unless severe and causing symptoms. More current thinking is that surgery should be performed once the left ventricle and left atrium show any signs of dilating. I think seeing an imaging specialist is a good idea.