All patients who have any symptoms and moderate or severe mitral regurgitation should be referred for surgical treatment. It is preferable to operate on patients early in their symptomatic course, as long term survival following mitral valve repair is compromised in patients with New York Heart Association Class III or IV symptoms (see Figure 1)2. Factors which determine timing of surgery for degenerative mitral regurgitation in the current European Society of Cardiology American College of Cardiology and American Heart Association and guidelines include the presence of symptoms, left ventricular (LV) ejection fraction (EF), LV end-systolic dimension (LV ESD), atrial fibrillation, and pulmonary hypertension1.
Dr Babar Bashir CHAUDHRI works in concert with expert cardiologists to evaluation patients with severe mitral regurgitation. Patients with symptoms, who have been found to have lesser degrees of regurgitation by prior investigations elsewhere will often be found to have increased mitral regurgitation, or inadequate increase in ejection fraction, on stress echocardiography and should also be referred for surgical consideration.
Asymptomatic patients with left ventricular dilatation (LV end systolic diameter more than 45 mm), decreased Ejection Fraction (<60%), atrial fibrillation or pulmonary hypertension (PA systolic pressure > 50 mm Hg at rest or > 60 mm Hg with exercise) should also be considered for elective mitral valve surgery.
Patients with asymptomatic moderate to severe mitral regurgitation should be carefully followed up. Attention is focused to repeated measurement of ejection fraction over the course of time. A drop to <60% confers poorer long term survival even with successful mitral valve repair. Patients with severe quantitative mitral regurgitation (effective regurgitant orifice of at least 40 mm2) have significant morbidity including increased mortality during follow up and should be considered for surgery.
Dr Babar Bashir CHAUDHRI will discuss all treatment options with you and will recommend surgery to all symptomatic patients and also generally to all asymptomatic patients with severe mitral regurgitation.