Surgeon Q&A: The Risk Vs. Benefit of Asymptomatic Mitral Valve Surgery

www.Heart-Valv... - Patients with asymptomatic mitral valve disease are often very confused. They feel fine and have no symptoms. However, mitral regurgitation is an insidious cardiac condition that cause many health risks including atrial fibrillation and death.
As a result, asymptomatic patients have many questions about the severity of their disease, how to monitor it, and when is the right time to have surgery. They may also have questions about diagnostics tests including echocardiograms, transesophageal echocardiograms (TEE) and the key indicators of disease severity including the effective regurgitant orifice (ERO).
For example, Erica asks, "What is the latest opinion on risk versus benefit of 'watchful waiting' for mitral valve repair versus proactive surgery if a patient is asymptomatic but has severe regurgitation?"
To answer this question, we met with Dr. Junaid Khan, a leading cardiac surgeon from Alta Bates Summit Medical Center in Oakland, California. Dr. Khan is a leading heart valve expert and regularly performs mitral valve surgery. In this video, Dr. Khan answers Erica's question and provides insights specific to asymptomatic mitral valve disease caused by conditions including mitral valve prolapse.
To contact Dr. Khan for an appointment or second opinion, please call [phone] or visit www.heart-valv....

[@chuckthomas7758]

I had my mitral valve repaired August 29, 6 weeks ago. Mine was severe, didn’t realize how bad it was. Just ignored, what I now know were symptoms, until I had to seek help. Don’t wait. You will get sicker slowly. It doesn’t get better. Get it taken care of before you are debilitated.

[@HeartValveSurgery]

Hi Chuck, Great points. Thanks for sharing your mitral valve repair experience with our community. Interesting to hear how you didn't realize how bad your mitral regurgitation was. Yes, this is common feedback we receive from patients who think they are asymptomatic but actually are not really.

[@rider275]

I have a TEE coming up next month. I will ask the cardiologist about ERO. I learned something new today. Thank you!

[@HeartValveSurgery]

Glad it was helpful!

[@williamfeldner9356]

There are risks to any surgical procedure. My wife was asymptomatic with a leaking mitral valve and a moderately enlarged atrium. We decided to go ahead and have the surgery at the Cleveland Clinic. Now unfortunately we are dealing with heart arrhythmias…… obviously the heart does not enjoy being cut. The electrical paths of conduction have been severed and altered……. The old methodology of waiting for symptoms may have been better in our case, because now we are dealing with a new set of problems……. Difficult decision…….

[@HeartValveSurgery]

Hi William, Sorry to learn that your wife is having post-op arrhythmias. How long ago did she have surgery? Fyi, if she is experiencing atrial fibrillation, that is a relatively common post-op complication. Here is a video all about AFib after heart valve surgery that might be helpful for you - kzbin.info/www/bejne/rGHUiYaZiciHhc0.

[@HobbyOrganist]

My view is; It will ONLY get worse with time/age Medial costs will only get higher over time The regurgitation causes compensatory changes in the heart that themselves in turn cause other problems. It's the kind of thing better addressed and fixed sooner than later. I had mitral valve regurgitation for some 40 years, it didnt have any symptoms until it DID, I came down with pneumonia and tachycardia, not sure about the pneumonia's cause, but with heard dilation etc trying to compensate for the leaking mitral valve, that apparently caused the tachycardia- I had that/156bpm for at least 3 days that I know of while I was being treated outpatient for the oneumonia in one lower lobe. They did a cardioversion and medication, I told the cardiologist I didnt want a bandaid fix with medications for the two problems, and that I wanted to put a permanent surgical FIX on the table for discussion, since these thingso nly get worse, and while I'm not yet retired I still have insurance at WORK that will cover the costs. So a short time later I went in for open heart surgery, he was able to repair the valve and add an anular ring, but the Cox MAIZ procedure didnt work, so they wound up implanting a pacemaker the next morning. Now 3-1/2 years later, no medications at all, no problems since.

[@HeartValveSurgery]

Several good points. Thanks for sharing your story with our community!

[@davidpowell3347]

I doubt that the patient will still be asymptomatic once atrial fibrillation ensues from the mitral regurgitation.

[@HeartValveSurgery]

Good point. Symptoms of atrial fibrillation can present in up to 35% of mitral valve patients.

[@Raj-ul9my]

I have 3 valves that have mild regurgitation, my cardiologist said its how i was born. I sometimes suffer from palpitations and sometimes chest pain, do I need repair surgery?

[@HeartValveSurgery]

You raise a really great question. Unfortunately, as a patient advisory group, we are not trained or capable of providing specific medical advice. That said, we would strongly encourage you to discuss this question with your medical team. If you are not getting information that you are comfortable with then perhaps you should get a second opinion to validate and support next steps in the treatment process. We are sorry that we cannot be of more help to you. We hope you can understand!

[@texless69]

👏👏👏

[@HeartValveSurgery]

Great to hear you enjoyed this video with Dr. Junaid Khan about asymptomatic mitral valve surgery.