mitral valve repair for chf

[chuck3220]

I am a 71 year-old female who was diagnosed with chf on 1/31/09.  My ef at that time was 15%.  I also had significant mitral valve regurgitation.  I was prescribed Coreg and lisinopril.  My most recent echo (May, 2010) shows ef of 20%.  MVR was mild to moderate at that time.  My question....when is mitral valve repair/replacement considered to improve heart function?

[kenkeith]

I have moderate to severe MVR diagnosed 6 years ago.  At that time I also, was hospitalized with congested heart failure, EF 13-29%, occluded coronary vessels, MVR and enlarged left ventricle. It appeared the ischemically enlarged heart caused the MVR.  The medical decision was treat the enlarged left ventricle and occluded vessels with lisinopril and coreg. Currently, my heart is a normal size and EF is 59%, but I still have moderate to severe MVR...the doctors thought if and when the heart returned to normal size the MVR would improve, it didn't.  I don't have any symptoms, and if I have shortage of breath, fatigue, chest pain, etc. there would be intervention on the MVR.

I don't know your medical history, and the underlying cause for your low EF, but because you are treated with an ACE inhibitor and beta blocker, I assume you have CAD, and that has caused your heart to have the abnormal pumping ability from an enlarged heart.  With you low EF, an operation to repair or replace your mitral valve will have little effect to improve your EF.  A renown valve surgeon from the Mayo Clinic has stated the biggest problem he sees is a patient has waited too long and heart functionality will more than likely not return to normal with valve surgery.

Many individuals do well with mild to moderate MVR, but to answer your question when to consider MVR intervention is before the EF is reduced and heart size is normal.  Mild to moderate MVR is not life threatening but it does place an added stress to the heart as each heartbeat is pumping less output because some blood flows back into the left atrium.