Mitral Valve Prolapse: When to Consider Surgery? - Gastroenterology and Hepatology

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Mitral valve prolapse (MVP) is a condition where one or both of the mitral valve leaflets bulge (prolapse) back into the left atrium during the heart's contraction. This can sometimes lead to mitral regurgitation, where blood leaks backward into the atrium. Understanding when to consider surgery for MVP is crucial, especially when symptoms and the severity of the condition evolve over time.

Based on your description, it seems that you have been experiencing symptoms such as palpitations, chest tightness, shortness of breath, and dizziness, which can be associated with MVP. The fact that your doctor noted a worsening of the prolapse but no significant regurgitation is an important point. Mitral valve surgery is typically considered when there is significant mitral regurgitation that leads to symptoms or when the heart begins to show signs of strain or dysfunction due to the regurgitation.


When to Consider Surgery for Mitral Valve Prolapse
1. Severity of Symptoms: If your symptoms are significantly impacting your quality of life, surgery may be considered even if the regurgitation is not severe. Symptoms like persistent palpitations, fatigue, and shortness of breath that do not improve with conservative management warrant further evaluation.

2. Progression of the Condition: Regular follow-ups with echocardiograms are essential to monitor the progression of MVP. If your condition is worsening, as indicated by your recent echocardiogram, it may be time to reassess your treatment options.

3. Heart Function: If tests show that your heart function is declining or if there are signs of left atrial enlargement or pulmonary hypertension, surgical intervention may be necessary to prevent further complications.

4. Patient Preference and Lifestyle: Given that you work in a medical setting and are aware of your condition, your personal comfort with the situation and your lifestyle demands should also be considered. If your work is becoming increasingly strenuous and your symptoms are exacerbated, discussing surgical options with your cardiologist may be prudent.


Surgical Options
If surgery is deemed necessary, there are generally two main approaches:
- Mitral Valve Repair: This is often the preferred option as it preserves the valve's function and structure. Repairing the valve can alleviate symptoms and improve heart function without the need for lifelong anticoagulation therapy.

- Mitral Valve Replacement: In cases where the valve cannot be repaired, replacement with a mechanical or biological valve may be necessary. This option typically requires lifelong anticoagulation therapy for mechanical valves.


Consultation with Specialists
Since your primary physician has not recommended surgery, it may be beneficial to seek a second opinion from a cardiologist or a cardiac surgeon who specializes in valvular heart disease. They can provide a comprehensive evaluation of your condition, including the severity of the prolapse, the presence of regurgitation, and the overall impact on your heart function.


Conclusion
In summary, the decision to proceed with surgery for mitral valve prolapse should be based on a combination of symptom severity, echocardiographic findings, heart function, and personal circumstances. Regular monitoring and open communication with your healthcare providers are key to managing your condition effectively. If your symptoms persist or worsen, do not hesitate to advocate for further evaluation and discuss the possibility of surgical intervention. Your health and quality of life are paramount, and you deserve a treatment plan that addresses your concerns and needs.