Timing of mitral valve repair

[LTB39]

I am a 39 year old female (132 pounds) who was just diagnosed with mitral regurgitation (grade 3-4) / mitral valve prolapse and tricuspid regurgitation (grade 1). My LVEF is 55%, and both leaflets prolapse and are thickened.
I have been symptomatic since high school (in hindsight, but had always attributed symptoms to asthma or stress), but have really noticed an increase in the frequency and severity in the past 6 months, and a marked increase in the last 3 week, including palpitations, chest tightness, series of 3-4 beats, dizziness (co-workers haved noticed I seem disoriented and take care of me), and shortness of breath.

I'm trying to figure out the results of my echo:
LV Diastole (LVED) 5.3 cm
LV Systole (LVES) 3.2 cm
LVEF 55%
E:A ratio 1.0
Decel time 160 ms
MVA 2.7 cm2
Mitral regurgitation 3-4
TR Vel 1.8 m/s
TR Gradient 13 mmHG
EST RAP 10 mmHg
EST RSVP 23 mmHg
Tricuspid Regurgitation 1

I've done the Cleveland Clinic's mitral regurgiation tool, which indicates that I may be a candidate for repair.  What are the criteria to consider when I make the decision about the timing of a repair?  Are there places in the US where a repair can be done less invasively?  I don't believe that is an option in Austin, Texas where I live.

I also have 2 specific questions:

1. Can it be significant that the regurgitant jet seems to hug the wall and reaches back into my pulmonary veins?  What questions should I be asking about this? Is there any medical literature on this (I have access to Up To Date through my husband).

2. Is there a difference in the size of the left ventricle and men and women? I noticed that the LVED is 5.3. One source I consulted seemed to indicate that this was a typical reading for a man, but that women were typically 4.6 +/- .3, so could that mean that my left ventricle is enlarged?  Again, what questions should this prompt and is there any medical literature on this?

There is a significant history of heart problems in my maternal family: 3 heart attacks (57, 64, 70s), sudden death from heart issue (51), and high cholesterol.  I do not smoke, drink only moderately (1-3/week max), and eat a healthy diet. My only other medical condition is asthma (which has caused 2 hospitalizations and an intubation).

[kenkeith]

I have moderate to severe MVR for more than 6 years.  There are 4 levels of degree of regurgitation and 3-4 is the higher range.

I saw my MVR while being tested with an echo.  I understand one method to determine degree of backflow relates to the height of jet stream and location,  My jet hit the side of the atrium and the location is the opposite side.  It seems intuitively that a higher jet stream would indicate a smaller leak or higher left ventricle pressure.

My MVR was believed to be the result of an enlarged LV and that condition skewed the orifice (valve opening) orifice. I'm not clear on the LV size in connection with your MVR?  It is usually the left atrium that increases in size with MVR.  It seems there is a gender distinction for LV size.

Your EF (ejection fraction...normal is 55 to 75% and represents the percent of blood pumped with each heartbeat) is normal.  Your right side pulmonary pressures is very good.

A renown cardiac surgeon at the Mayo Clinc stated the biggest problem with MVR patients is that they have waited too long.  By waiting too long often there is a loss to left ventricle pumping ability (EF) to return to normal.

Thanking you for sharing,