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Question:

What is the general progression of mitral valve disease in a young healthy adult?

I am a 38 yr old healthy young male. I was diagnosed with a grade 3/6 systolic murmur and underwent an echo and a TEE that shows myxomatous mitral valve with moderate MR eccentric in nature. Bi-leaflet prolapse with majority of it located at the P2 scallop of the posterior leaflet with suspected secondary chord rupture noted in the view #56 and #70. No flaility of the leaflet noted. There is no wall thickening and normal EF of 65%. I have no symptoms. I have mild HTN and am currently taking lisinopril 20mg. I have a few questions:
1. What is the general prognosis regarding progression of the disease process toward needing mitral valve repair?
2. What is the significance of the eccentric jet in grading the severity of the regurgitation?
3. What is significant of the secondary chord rupture?
4. What is the best way to follow my regurgitation, ECHO,TEE, 3D Echo, or MRI and is every 6 months or once a year appropriate?
5. Am I limited in exercise? Can I do a cardio workout or aerobic exercises? Can I do moderate to low weight lifting with high repetition and low weights?

Submitted by Michael from Michigan on 10/22/2013

Answer:
by Patrick J. Cook, MD

1) It’s quite variable. There do not presently seem to be indicators of an impending need for mitral valve repair.
2) Consideration of MV repair in an asymptomatic patient requires severe regurgitation. Eccentricity is neither here nor there in that regard.
3) It’s better not to have it, but, again, nothing else suggests an imminent need for MV repair.
4) Clinical status and some sort of echocardiographic imaging is superior to MRI. A good transthoracic echo (TTE) should suffice, with more advanced echo modalities reserved for a change in clinical status or worsening mitral regurgitation (or some other significant change on echo).
5) No. Yes. Yes.