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Question:

What is optimum timing for me to pursue another mitral valve repair or replacement?

I had a mitral valve repair in April of 2008. . .After initial complications including pleurisy, the repair went well. I am now in declining health with intermittent A-fib (as monitored during local hospital admissions), shortness of breath, swelling of fingers and toes, and fatigue.

March 2013 MRI tests show a severely enlarged left atrium. . .bi-leaflet mitral valve prolapse, and mitral regurgitate fraction = 34% . . . [and additional findings].

I’d like to understand if this is normal after five years, should I be concerned about near term remediation, and what to expect in the future. With the prior listed conditions, can you advise if and/or when it would be appropriate to pursue another mitral valve repair and/or replace. [Question edited for brevity.]   

submitted by Rodney from Gulf Breeze, Florida on 4/15/2013

Answer:

by Texas Heart Institute cardiologist, Raymond Stainback, MD  

Raymond F. Stainback, MD, FACC, FASEYou have described a mitral valve repair, now with some significant degree of residual or recurrent mitral regurgitation (MR). The question of re-operation would depend upon presence or absence of symptoms, left ventricular function, confirmation of mechanism and severity of current MR in order to determine ability to re-repair vs prosthetic replacement. Overall risk benefit assessment also includes patient age and any other concomitant medical conditions.    

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Updated April 2013
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