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Avatar universal

Valve repair or wait?

50 yr old with dilated cardiomyopathy started at age 20. 7x month history of atrial fib. Mild to moderate MV prolapse. I'm tired with little exertion. It's getting worse. Suspect meds (toprol and lisinopril) don't help energy level. I feel a repair would help but with mild to moderate prolapse some believe it's not necessary. Subjective symptoms dictate otherwise. What do you think? TEE scheduled.
5 Responses
242509 tn?1196926198
MEDICAL PROFESSIONAL
I think it depends on both the severity and the mechanism of the mitral regurgitation. We generally don't operate on mild or moderate mitral regurgitation irrespective of mechanism, unless there is a compelling reason for surgery. How is your atrial fibrillation controlled? Have they attempted to place in normal sinus rhythm with medications or cardioversion?
21064 tn?1309312333
Wait for the results of your TEE.  It is a good test to determine what's going on with the valves.  Any idea of the amount of regurgitation you have been estimated to have?  It is usually graded on a scale of 1-4, 4 being severe.  When is your TEE?  

Check out this summary by the American College of Cardiology.  The section on MR and surgery begins on page 35.  From what I can gather, unless you have severe regurgitation, you may not be refeffered for surgery.  However, because you are symptomatic, other factors may come into play.  
http://www.acc.org/qualityandscience/clinical/guidelines/valvular/Valvularpocketguide.pdf

Please keep us posted.  Enjoy the day!
Avatar universal
Thank you so much for the reply. MY MV peak is .58m/sec and I have an EF of 38%. I cannot find any additional information which might indicate a grading scale of the degree of MR except for the qualitative mention of mild to moderate. I am aware that that there is an inherant bias in performing these tests. A TEE is scheduled for 11/12/07. I am hoping that this will provide some additional, useful information and definitive treatment. Once again, your reply is greatly appreciated. Thank you.
21064 tn?1309312333
We are the same age (young!) and I also have mitral regurgitation.  I ran into a similar situation a few years back when I was increasingly tired and short of breath.  An updated echo revealed a "moderately severe" leaking mitral valve.  My doctor referred me to the CC for a TEE.  I had the TEE and it was read as 2 - 3+ MR.  The doctor said I was not a candidate for surgical repair.  I still have semi-annual checkups (echos and stress echos) to watch for any changes.

Generally, the regurg is graded something like this...
1.  Trivial, psysiologic, trace
2.  Mile
3.  Moderate
4.  Severe    Sounds as though your last echo would place you at 2 - 3.  The TEE should give you a better idea.

Good luck with the test.  I hope you get some answers and that you feel better soon.  Please let us know how you make out.
Avatar universal
God bless both of you. Dear, CCFheartMD-CA, thank you for this site.
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