An asymptomatic 54-year-old woman has severe chronic primary degenerative mitral regurgitation. Echocardiography shows LVEF 57%, LVESD 43 mm, PASP 38 mmHg, sinus rhythm, and good probability of durable repair. What is the appropriate management?

• A Start an ACE inhibitor and reassess in two years
• B Annual surveillance until symptoms or LVEF below 50% develop
• C Mitral valve repair is indicated even in the absence of symptoms ✓
• D Refer for transcatheter edge-to-edge repair now

Explanation

In chronic severe primary mitral regurgitation, surgery is indicated once irreversible left ventricular dysfunction threatens: LVEF of 60% or less, LVESD of 40 mm or more, new atrial fibrillation, or pulmonary artery systolic pressure above 50 mmHg at rest. This patient meets the criterion on both LVEF and LVESD, so repair should proceed despite absent symptoms, since outcomes are best when operated before dysfunction appears. ACE inhibitors do not halt progression of primary degenerative MR.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.