Mitral Valve Regurgitation - when to have surgery

[staley]

50-ish yr old male with mitral valve regurgitation.  My echo showed ejection fraction of 60% (between 55 and 75), left ventricle is in the upper normal range, mild mitral regurgitation, right ventricle size and function is normal.  

I participate in cardio type sports three times per week and want to continue to do so.

My question is when, if at all, should I have surgery to have the valve repaired.  I am young and strong enough to tolerate the surgery now.  I don't want to risk irreversible damage to the heart, as I want to continue my active lifestyle.  My doctor said its mild now so is not even talking surgery.

[staley]

Thanks to you too.  Will keep an eye on it with yearly checks, unless symptoms arise.

[staley]

Thanks. The cardio told me to come back in a year. Right now, no problems with exercise. Thanks for the info. Will keep exercising and good diet and go back in a year, unless symptoms arise in which case he said to come in right away.

[Jerry_NJ]

Good question and one that is too late for me to ask.

I started with an irregular heart beat at about the age of 55.  I was still a runner so I had regular aerobic HR in the 160 range.  This exercise level is in fact what caused me to detect the irregular HR, I had no outward symptoms.

I was diagnosed with atrial fibrillation (common, I fear, among extreme athletes, not me, and tall people, me) at age 57.  This led to echocardiograms and nuclear stress tests.. and I was diagnosed with a good EF and a "leaky" mitral valve (regurgitation).  My cardiologist tried drugs to stop the AFib and when that didn't work I was given an electrocardio version followed by drugs.  This (repeated every year plus) kept me in NSR most of the time for another 10 years.  Then my cardiologist said:  no more electrocardioversions as my left atrium is too enlarged (care to guess why?) and referred me to  a heart surgeon.  I had mitral valve surgery with a mini maze at age 67.  To this I can say the idea of surgery scared the ... our of me, but the experience was not bad at all, the only down side was the risk, now long passed.  The surgeon gave the maze a 60% chance of stopping the AFib and the repaired mitral valve would allow the enlarged left atrium to shrink back some, how much?  Unknown, result on shrinkage: not much if any...but I'm an old guy, what can I expect.

Bottom line, I am in permanent AFib and I no longer run.. well I'm too old to run anyway and at 225 pounds (6' 5" and growing shorter) my joints can't take running anyway.  But the AFib prevent me from even serious walking, I get around fine, but up hill or fast walking soon ends for a rest.  Bike riding is now a level street only affair.

So, to you question, I have wondered:  What if I had my mitral valve repaired sooner, would I still have AFib?  I have not discussed with my cardiologist, I am sure his reasoning was the risk was too high to do surgery before the threat of congestive heart failure was the alternative.  I had the old fashioned surgery through the sternum.  

A younger athletic colleague, who was closer to 6'7" and had AFib which came on so strong he went form ER then soon to Surgery.  He had a mitral valve repair and mini maze, and he has been in NSR and still playing basketball for recreation years after the surgery.  

I think your question is how much heart enlargement are you risking by not repairing the mitral valve, what increased risk of AFib are you exposed too?

The atrium can not sustain continuous (each beat) back-pressure from the powerful ventricle muscles without undergoing enlargement - but a "mild" leak may not allow that much pressure into the atrium.

I think your concern is well based, not a question to be ignored. As a minimum get an annual echo, even if you have to pay out-of-pocket (not that expensive) with a careful watch on size change/enlargement.

[Smiley2000]

Hi there,

20% of the population has mild to sometimes even moderate regurg of heart valves and don't even know about it and stay asymptomatic and some needs surgery later in life.

I had my mitral valve repair done when I was 31, but I was in total heart failure at the time and EF 35% and pulmonary hypertension and left atrium enlarged, Grade 6 regurg.  6 months prior to my MV repair I had cardiac Ablation for SVT's and A-fib and that was also a sign that my heart was not doing to well.

It is advisable to see your Cardio Annually to ensure that your heart does not enlarge and the grading of your regurgitation does not change.  Grade 0 - 3 is mild.  Grade 4 moderate and Grade 5 - 6 is severe and need intervention.

As long as you have good exercise tolerance and no signs of heart failure, you won't need surgery.

Keep on exercising as it is good for the heart and over-all health and I wish you all the best :)

[staley]

Thanks. That sounds good.

[ed34]

I think if you knew how common mild regurgitation of the mitral valve is, you wouldn't even give it a second thought. Once and IF it becomes moderate, then Doctors may consider repair, but it is likely that your valve will stay mild, and has been for many years.

[Occupant]

My echo shows basically the same thing except they said mild mitral valve regurgitation and nobody even hinted at surgery and my echo was three years ago. So, why do you even hink about it, you think you are better than me:)?