For mitral valve prolapse, when is surgery recommended and which symptoms should one look for?
Recommendations for surgery in patients with mitral valve prolapse (MVP) and mitral regurgitation (MR) are the same for other forms of nonischemic MR:
- Symptomatic patients with normal left ventricular (LV) function or LV dysfunction.
Surgery is recommended for patients with heart failure symptoms, such as dyspnea, orthopnea, paroxysmal nocturnal dyspnea, leg edema, etc.
Among patients with very mild symptoms, surgery is recommended particularly when the valve has >90% chance of being repairable [Class I-B].
- Asymptomatic patients with LV dysfunction.
The timing of surgery for asymptomatic patients is controversial, but there is an agreement that MV surgery is indicated when LV dysfunction is present (LVEF 30-60% and/or LV end-systolic dimension >= 40 mm) [Class I-B].
- Asymptomatic patients with normal LV function.
MV repair is reasonable in experienced surgical centers for asymptomatic patients with chronic severe MR and preserved LV function [Class IIa-B]. MV surgery should also be considered for this group of patients with new onset of atrial fibrillation [Class IIa-] or pulmonary hypertension (pulmonary artery systolic pressure >50 mmHg at rest or >60 mmHg with exercise) [Class IIa-C].
Nishimur RA, et al. ACC/AHA 2014 practice guidelines for the management of patients with valvular heart disease: executive summary. JACC 2014 Jun 10;63(22):2438-88