Mitral Valve Insufficiency: When Is Surgery Necessary?

Incomplete membrane closure

Hello, Doctor:
If I remember correctly, when I was younger, I had a heart murmur and noted left ventricular hypertrophy during my annual employee health check-up.
Since I had no symptoms or discomfort, I did not seek medical follow-up.
About ten years ago, I was prescribed medication for early-stage hypertension at a clinic, and I have been taking the medication regularly (still taking it once after breakfast).
Regarding the heart murmur, the doctors did not provide any specific instructions.
Earlier this year, I saw a young physician due to a cold, and he reacted dramatically to my heart murmur.
Following the advice of my original physician who treated my hypertension, I underwent several tests at the hospital, including an electrocardiogram, echocardiogram, transesophageal echocardiogram, and cardiac catheterization.
I am currently waiting for a non-contrast computed tomography scan.
The cardiologist has determined that I have severe mitral valve regurgitation and has referred me to a surgeon for potential surgery.
I would like to ask if it is absolutely necessary for me to undergo surgery, considering that I am still living a normal life, walking briskly for 30 minutes every day, and have no significant symptoms or discomfort.
Please explain, thank you.
Best regards,
Shiqi

aben, 60~69 year old female. Ask Date: 2019/06/02

Dr. He Dongjin reply Cardiology

Hello, I suggest that you gather all your examination data and seek a second opinion from another physician.
Personally, I hold a more reserved attitude and might consider it when there are active symptoms of wheezing.
Changhua Hospital cares about you.

Reply Date: 2019/06/02

More Info

Mitral valve insufficiency, also known as mitral regurgitation, is a condition where the mitral valve does not close properly, allowing blood to flow backward into the left atrium when the left ventricle contracts. This can lead to various complications, including heart enlargement, atrial fibrillation, and heart failure. The decision to undergo surgery for mitral valve insufficiency is complex and depends on several factors, including the severity of the condition, the presence of symptoms, and the overall health of the patient.

When is Surgery Necessary?
1. Severity of Regurgitation: The degree of mitral valve insufficiency is typically assessed through echocardiography. If the regurgitation is classified as severe, surgical intervention is often recommended, even in the absence of symptoms. This is because severe regurgitation can lead to progressive heart dysfunction over time.

2. Symptoms: While some patients may remain asymptomatic for years, the onset of symptoms such as shortness of breath, fatigue, palpitations, or swelling in the legs can indicate that the heart is struggling to cope with the volume overload caused by the regurgitation. If symptoms develop, surgery is usually warranted.

3. Left Ventricular Function: The function of the left ventricle is a critical factor in determining the need for surgery. If echocardiographic studies show that the left ventricle is dilating or its function is declining (ejection fraction less than 60%), surgical intervention is often recommended to prevent irreversible damage.

4. Atrial Fibrillation: The presence of atrial fibrillation, a common arrhythmia associated with mitral valve disease, can also necessitate surgical intervention, as it may lead to an increased risk of stroke and other complications.

5. Patient's Overall Health: The patient's overall health and ability to tolerate surgery are also crucial considerations. If a patient has significant comorbidities that may complicate surgery or recovery, a more conservative approach may be taken.

Monitoring and Follow-Up
For patients who are asymptomatic and have mild to moderate mitral regurgitation, regular follow-up with echocardiograms is essential. This allows for monitoring of the condition and timely intervention if there are changes in symptoms or heart function. Typically, follow-up echocardiograms are recommended every 6 to 12 months, depending on the severity of the regurgitation and the patient's overall health.

Surgical Options
If surgery is deemed necessary, there are generally two options: mitral valve repair and mitral valve replacement. Repair is often preferred when feasible, as it generally has better outcomes and preserves the patient's own valve structure. Replacement may be necessary in cases where the valve is too damaged to repair.

Conclusion
In your case, while you are currently asymptomatic and maintaining a normal lifestyle, the assessment of your mitral valve insufficiency by a cardiologist is crucial. Given the findings of severe regurgitation and the potential for future complications, it is advisable to discuss the risks and benefits of surgery with your healthcare team. They can provide personalized recommendations based on your specific situation, including the results of your upcoming imaging studies. It is essential to weigh the potential benefits of surgery against the risks, especially considering your current health status and lifestyle. Regular monitoring and open communication with your healthcare providers will be key in managing your condition effectively.

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