SEVERE MR 2d echo. Required immediately?

This echo shows severe mitral regurgitation (MR) due to mitral valve prolapse (both AML and PML prolapse). Reassuring points: * LV pumping function is still preserved: EF 62% * LV size is still within acceptable range: LVIDs 3.3 cm * No pulmonary hypertension * No regional wall motion abnormality * Young age (26 years) is favorable if repair is needed Bad signs: * Severe MR * Dilated left atrium (LA 4.2 cm) * Thickened prolapsing leaflets In severe MR due to MVP, surgery is usually advised when one or more of these occur: * Symptoms: breathlessness, reduced exercise tolerance, palpitations, fatigue * LV function starts dropping * LV begins enlarging * Pulmonary hypertension develops * New atrial fibrillation occurs * Very high likelihood of durable valve repair in a young patient

prefer early elective mitral valve repair before permanent heart enlargement or LV dysfunction develops. get a: * Repeat high-quality echocardiogram (preferably at a good cardiac center) * Ideally a TEE (Transesophageal Echo)

If there is: * No breathlessness, * No AF, * Normal exercise tolerance, * Stable LV dimensions, then surgery may be planned electively after proper evaluation rather than urgently.