When to schedule Mitral Valve Surgery

[OR4514]

? I'm interested in the current thinking of when to undergo Mitral Valve surgery. Specifically whether it's better to have it done before reaching the severe level, and whether having it done earlier than later would increase the chances for a repair versus a replacement. As well as improve my chances for a minimally invasive procedure.

Since I'm asymptomatic, can exercise, and have no apparent life style limitations currently, my deciding when to have surgery is based upon the following considerations.
- Would having it done sooner improve my chances of having a repair?
- Would having it done sooner improve the success of the surgery?
- Would having it done sooner improve my chances of having a minimally invasive procedure?

If you could enlighten me on these subjects, I would really appreciate it. My cardiologist has indicated he would recommend your facility for this surgery, and help set up the surgical consultation when I'm ready.

The following are my current conditions and TEE report highlights. If any of this is significant information which would determine whether I'm a candidate for repair or not, I would be interested.
Also if it helps determine if the minimally invasive procedure is appropriate for me.
thank you! your forum has been very helpful.

Age-51, 6' 3", 200 lbs.
Diagnosed with Mitral regurgitation at age 48.
Regurgitant Fraction of 58% (Moderate-to-Severe)

Asymptomatic
Generally in good health/exercise regularly
taking Metoprolol 50mg/daily for blood pressure
taking Hydrochlorothiazide 25mg/daily

TEE report highlights.
1>Prolapse of the posterior mitral valve leaflet.
Appears to be prolapse of the tip of the anterior Mitral valve leaflet.
As a result of these prolapses and myxomatous change of the Mitral valve, there are three separate regurgitant jets of Mitral regurgitation that are noted.
Vena contracta of 0.4, regurgitant volume of 122 cc and effective regurgitant orifice of 0.8. There is also evidence of mild dilatation of the Mitral annulus, which is measured at 3.6 cm.

2>Aortic valve is structually normal.

3>Tricuspid valve is structurally normal.Trace tricuspid regurgitation is noted with probably normal pulmonary artery presures.

4>Pulmonic valve is structurally normal. Mild pulmonic insufficiency.

5>Right/Left Ventricle appears to be normal in size. Systolic function appears to be preserved iwht ejection fraction estimated at around 60-65% at rest.

6> Right Atrium appears to be probably grossly normal in size. The left atrium, in limited views, appears to be at least mildly dilated.

Conclusion:
a) Moderate-to-severe mitral regurgitation secondary to the prolapse of the posterior and probably anterior mitral valve leaflets and mild mitral annular dilatation.

b) Preserved left ventricular function with ejection fraction of 60-65%.

end.
thanks again,
Oregon

[OR4514]

thank you for your help, I will repost as you suggested.
I appreciate you taking your time in responding.

[va_tony]

You'll need to repost you question on one of the expert forums if you'd like a cardiologist to answer.  This board is for patient to pateint support.

Here's what one med site says in answer to your question:

"The indications for mitral valve repair are undergoing constant re-evaluation. Recent evidence suggests that earlier surgical intervention, particularly if repair is possible, may prevent irreversible damage to the heart. The decision regarding when to proceed with surgery should be made with your doctor. This decision will require judgment regarding the risk of surgery and the benefits available from surgery. In some cases blood pressure medications, such as ACE-inhibitors can significantly relieve symptoms.

Severe mitral regurgitation in the presence of symptoms of congestive heart failure is usually an indication for surgery. Severe regurgitation diagnosed by echocardiography, even without symptoms, may be sufficient to warrant repair. Enlargement of the left atrium, particularly in the setting of the recent onset of an irregular heartbeat (atrial fibrillation, premature atrial contractions, paroxysmal atrial tachycardia, etc.) is considered by many doctors also to be an indication for surgery."

http://www.sts.org/doc/4107