Expert Insights on Nonrheumatic Mitral Valve Disorder and Management

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Hello Director: Thank you for your previous response.
I have now downloaded the examination report.
Could you please provide me with your opinion again? Thank you!
Echocardiogram (including single and dual views)
Examination Date: 02/27/2019
Diagnosis: Non-rheumatic mitral valve disorder, unspecified
Report Date: ## Findings: Left atrial (LA) and left ventricular (LV) dilatation, interventricular septum (IVS) hypertrophy, adequate LV systolic function (ejection fraction: 72.6%), normal LV diastolic function, severe mitral valve prolapse (MVP) of the posterior leaflet with severe mitral regurgitation (MR) (images 1/22-24), suspected chordae tendineae rupture, mild tricuspid regurgitation (TR).

## Comment: Transesophageal echocardiography (TEE) is indicated for further evaluation of the morphology of the mitral valve and the etiology of severe MR.
Computed Tomography Angiography - Non-contrast
Examination Date: 06/24/2019
Imaging Findings: CT of the chest: High-resolution axial imaging, unenhanced axial imaging, and reformatted imaging were obtained.
Mild plate-like opacities are noted in the left lower lobe of the lung.
Lymph nodes are observed in the mediastinum and bilateral axillae.
The trachea and both main bronchi are patent.
Cardiac size is normal.
Spurring is noted on the cervical, thoracic, and lumbar spine.
There is calcified plaque in the soft tissue posterior to the cervical spine.
The hypoattenuating nodules are not specified.
Echocardiogram (including single and dual views)
Examination Date: 08/28/2019
MEASUREMENTS AND SCREENING:
Aortic Diameter (mm): 32
LA/AO: 1.5
Aortic Valve Cusp (mm): 19
IVSd (mm): 14
LVIDd (mm): 57
LVPWd (mm): 9
IVSs (mm): 15
LVIDs (mm): 35
LVPWs (mm): 18
Mitral Valve Deceleration Time (ms): 195
Mitral Valve Deceleration Slope (mm/s²): 6866
Ejection Fraction (Teich): 66%
Fractional Shortening (%): 37
AORTIC VALVE: AV Vmax 1.48 m/s.

MITRAL VALVE: Chordal rupture (+) multiple, anterior leaflet.

DOPPLER: E/A 1.34/0.75 m/s.
E/E’ 13.7, 7.4.
Reversal flow in pulmonary vein (+).

MISCELLANEOUS: Ao 3.29, LA 4.94, IVSd 1.49, LVIDd 5.71, LVPWd 0.99 cm, FS = 37%.
P.S.: Currently taking 20 mg of Amlodipine and 1.25 mg of Carvedilol after breakfast.
Morning and evening blood pressure is approximately 100-130/60-90, with a pulse between 50-70.
Overall, there are no significant symptoms or discomfort.

aben, 60~69 year old female. Ask Date: 2019/10/03

Dr. He Dongjin reply Cardiology

Hello, there is an issue with your mitral valve.
Regardless of whether surgery or medication is chosen, the goal is to remain asymptomatic.
Currently, if you are taking medication and do not have any symptoms or discomfort, it is advisable to continue with the medication and monitor your condition.
Long-term, surgery is recommended.
If you start experiencing symptoms such as shortness of breath during activities, it would be advisable to consider surgical intervention.
Changhua Hospital cares about your well-being.

Reply Date: 2019/10/03

More Info

Nonrheumatic mitral valve disorder, as indicated in your report, refers to any dysfunction of the mitral valve that is not caused by rheumatic fever. This condition can manifest in various ways, including mitral valve prolapse (MVP), mitral regurgitation (MR), and other structural abnormalities. In your case, the findings suggest severe mitral valve prolapse with significant regurgitation, likely due to ruptured chordae tendineae, which are the fibrous cords that connect the mitral valve leaflets to the heart muscle.

Understanding Nonrheumatic Mitral Valve Disorder
1. Mitral Valve Prolapse (MVP): This is a condition where the mitral valve leaflets bulge (prolapse) into the left atrium during the heart's contraction. While MVP can be benign, in some cases, it can lead to significant mitral regurgitation, where blood leaks backward into the left atrium, causing volume overload and potentially leading to heart failure if severe.

2. Mitral Regurgitation (MR): Severe MR can lead to symptoms such as fatigue, shortness of breath, and palpitations. In your case, the echocardiogram indicates severe MR, which is a critical finding that requires careful monitoring and possibly intervention.

3. Chordae Tendineae Rupture: This is a serious complication of MVP, where the chordae tendineae that support the valve leaflets become torn, leading to acute or chronic MR. This can result in sudden worsening of symptoms and may necessitate surgical intervention.

Diagnostic Imaging
Your echocardiogram findings show left atrial (LA) and left ventricular (LV) dilation, which are common in cases of significant MR due to volume overload. The preserved left ventricular systolic function (ejection fraction of 72.6% to 66%) indicates that your heart is still pumping effectively, but the structural changes suggest that the heart is under stress.

Transesophageal echocardiography (TEE) is recommended to provide a more detailed view of the mitral valve's structure and function, which can help determine the exact cause of the MR and guide treatment decisions.

Management Strategies
1. Medical Management: Given that you are currently asymptomatic, your physician may recommend a conservative approach, including regular monitoring and medications to manage blood pressure and heart rate. The medications you are taking (e.g., antihypertensives) are important for controlling any potential heart failure symptoms.

2. Surgical Intervention: If symptoms develop or worsen, or if the echocardiographic findings indicate significant deterioration in heart function, surgical options may be considered. This could involve mitral valve repair or replacement, depending on the severity of the valve dysfunction and the condition of the surrounding heart structures.

3. Regular Follow-Up: Continuous follow-up with your cardiologist is crucial. Regular echocardiograms can help monitor the progression of the disorder and guide treatment decisions. If you notice any new symptoms, such as increased shortness of breath, fatigue, or palpitations, it is essential to report these to your healthcare provider promptly.

Conclusion
Nonrheumatic mitral valve disorder, particularly with severe MR and chordae tendineae rupture, requires careful management. While you may currently be asymptomatic, the structural changes in your heart necessitate ongoing monitoring and potential intervention. Discuss your concerns and treatment options with your cardiologist to ensure the best possible outcome for your heart health. Regular follow-ups and adherence to prescribed medications will be key in managing your condition effectively.

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