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?