Time for surgical consult or not?

I am a 35 year old female w/ mitral valve insufficiency. I also have what appears to be refractory hypertension. One year ago, when hypertension was dx, an echocardiogram indicated only mild regurgitation of the mitral, aortic, and tricuspid valves. My physician, at this time (EP for pacemaker), said this would go away once BP was controlled. Over a year later, despite seeing a hypertension specialist and trying many different drug regimines, BP still remains high. Symptoms (shortness of breath with/without exertion, pulmonary congestion, cough, peripheral edema, palpatations (af), chest discomfort, extreme fatigue), as well as a previously undetected murmur prompted an echocardiogram in July '08. Echo indicated "severe mitral regurgitation" and "moderate pulmonary hypertension." Repeat echo in August indicated only "moderately-severe MR", moderate AR, mild pulmonary hypertension, and mild atrial enlargement. Based on this echo, physician (hypertension specialist) recommends just monitoring MR yearly while trying to control BP. Because of my profound symptoms, I'm not convinced this is the best coarse of action. My question is, should I have a surgical consult at this point and is more invasive testing (TEE/CATH) warranted? My measurements are as follows: LA: 3.6; LVIDd: 4.8; LVIDs: 3.4cm; EF: 50+/-5%. I thank you in advance for your professional insights?

[Michael J. McWilliams, M.D.]

It is true that controlling blood pressure will usually help decrease the degree of MR.  There are lots of medications out there to treat blood pressure and you should be able to find a combinattion that can treat your blood pressure.

If you someone is symptomatic from MR, that is an indication for MV surgery.  If you really have pulmonary hypertension, edema, atrial fibrillation and shortness of breath related to MR, it is probably time for surgery.  Rather than seeing a surgeon, maybe it is time for a second opinion with another cardiologist in a different group -- someone that specializes in valvular heart disease.  

I hope this helps.

[Jerry_NJ]

I suffered from a leaky mitral valve, asymptomatic except for AFib, and lived with treatment only for AFib for several years.  Conclusion: a leaky valve isn't a big problem if nothing else goes wrong...in my case the leaky mitral caused an enlargement in my left atrium that was becoming dangerous.  I had mitral valve repair last November.  

Not sure this story helps, I send in as one testimony to living with a leaky valve until it caused some serious problems.  I understand some people suffer mitral (and other) valve problems without the need to go "under the knife", and saw if they go in through the sternum.