I have a 7 year-old daughter (born 23 March 2003). Ealier this year, she wasdiagnosed with Congenital MV Regurgitation and I was referred to a peadiatirc cardiology surgeon. In May this year, the doctor recommended surgery to repair the valve or if necessary replace it. The conclusion from the cardiologist was that her echocardiographic features were consistent with congenital MR and the doctor was concerned that her EF had dropped from 69% to 58%. The diagnosis then was that she had congenital severe MV regurgitation. At the time she was on furosemide 40mg bd/ Captopril25mg po bd tds/spironolactone2mg po daily/ penVK 250mg po bd. She has since stopped the treatment.
Today (13 Ocotber), I went to seek a second opinion and my main concern is that the EF is now 70%. Is that good or bad? The echo test says thst there is severe prolapse of anterior leafet; doppler - severe MI. on the MV valve. All is normal on the AV, for TV: 2D is normal and doppler- TI (gradient of TI +/- 29mmHg). PV: 2D is normal again, Doppler- mild PI, acceleration time+/-100millisek.
LV-severe dilatation (ED:63mm) + volume overloadin. EF+/- 70%
AV - normal
TV - Normal + TI. Calculated systolic pressure +/-39mmHg
PV - Normal + mild PI. Mean PAP +/-28mmHg
May you please explain to me, in simple english what all this means? Does the change of EF indicate improvement? Is surgery absolutely necessary in this case?
Congenital mitral regurgitation of a severe degree is unusual but most often associated with congenital mitral valve prolapse. When a valve leaks severely, it causes the heart chambers to enlarge. If the dimensions you quote are correct, the left ventricle is severely enlarged for her age (in fact 63 mm would be large for an adult!). That is the indication to do surgery. If a dilated heart chamber shows a decrease in heart function (a drop in ejection fraction) that means that the heart is weakening from the extra work load. An ejection fraction of 70% is excellent and is typical for young hearts that are coping with a significant workload. If the left ventricle is severely enlarged, then it is appropriate to pursue a surgical intervention. You do not want to wait until the heart function changes negatively.
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