A 65-year-old man with severe chronic mitral regurgitation is asymptomatic. Echocardiography shows LVEF of 62% and left ventricular end-systolic diameter (LVESD) of 42 mm. According to ACC/AHA guidelines, what is the recommended management?
- A Mitral valve surgery now, based on LVESD criteria ✓
- B Mitral valve surgery now, based on LVEF criteria
- C Close follow-up with annual echocardiography
- D Start ACE inhibitor and beta-blocker, defer surgery
Correct answer: A. Mitral valve surgery now, based on LVESD criteria
Explanation
In chronic severe primary mitral regurgitation, surgery is indicated when LVESD is ≥40 mm (Stage C2), even if asymptomatic with preserved EF. LVEF ≤60% is also an indication. Here LVESD is 42 mm, meeting the threshold for surgical intervention (mitral valve repair preferred). The patient is at Stage C2 and should undergo surgery before irreversible LV dysfunction develops.
Reference: Braunwald's Heart Disease, 12th ed.
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