Moderate vs. Severe Mitral Valve Regurgitation

[cornerbax]

Hello, I've been reading excellent threads here for a little while. Thanks to every member for such great and informative info and for this forum in general.
I have a question that I can't seem to find clear answers on. I'm 48/M, and was diagnosed last October with AFIB. I was in the hospital for 3 days as they prescribed
Sotalol and I had to be monitored for 3 days, specifically on the QTC interval being under 500 on all EKG's which I was. I reviewed all of my labs while in the hospital, as well as my Echo and one thing that stuck out was I was listed with Moderate Mitral Valve Prolapse with Moderate to Severe Mitral Regurgitation. What is perplexing is there were a total of 4 cardiologists that saw me during the time I was in the hospital, one of them was an EP. Not one of the 4 doctor's mentioned a word about the Mitral Valve, they only suggested an Ablation. At the time I wanted to work hard on my diet, cut down alcohol, lose weight and exercise more, all of which I have done. Unfortunately, none of that has gotten me in Sinus Rhythm.

I did a lot of research and was still unsure of the Mitral Valve so I found a highly rated EP that I set an appointment with and consulted. This EP almost immediately said we should do another echo at their clinic and look closer at the Mitral Valve which Is what I did. That test came back as Severe Mitral Regurgitation, not "moderate to severe." My Atria is enlarged at 6.5cm and my Ejection Fraction is 51%. My Left Ventricle is moderately enlarged and my right atria and right ventricle are normal. I am on Sotalol, Diltiazem and Eliquis and for the last 8 months, the only times i've had any episodes of shortness of breath or dizziness is if I had alcohol the night before. This has only happened 4 times the last 8 months as I have primarily eaten very clean and cut alcohol down substantially. With that said, whether it's the AFIB or Mitral Regurgitation, the Alcohol definitely is a trigger for me so I keep it out of my daily diet with rare exceptions.

With this said, my current Cardiologist is referring me for surgery. They think they have a good enough view on my echo where they can see the Mitral Valves not fully closing, causing the level of regurgitation I have, where I wouldn't need a TEE, but the valve specialist they referred me too will review the Echo themselves. My questions are if there is a way to determine how bad my regurgitation is right now and what chance for Mortality there would be right now, as of today? I've read a stroke is the biggest issue with AFIB and the Mitral Regurgitation and i'm on eliquis 2x a day to prevent this, but i've also read that heart failure can occur as well with Severe Regurgitation which is my main concern. Are there any specific tell-tale signs/symptoms from the Echo or otherwise that would determine the risk factor for mortality at the current time due to the Mitral Regurgitation? Thank you very much in advance.

 

[Zoltania]

I can't speak about the Afib, but the severe mitral regurgitation, if it gets worse, would cause noticeable symptoms of heart failure such as shortness of breath. If that occurs, you might need to have your surgery scheduled sooner (urgent but not necessarily emergency surgery). I don't think you're likely to experience sudden death from the regurgitation, if that's what you're worried about.

 

[cornerbax]

Thank you for your response Zoltania. My current EP reviewed my Echo's and said I have some time, so he didn't
make it seems as though it was extremely urgent. I just like to research as it is my heart and when you read things
like Mortality can occur within 1 year of Severe regurgitation, etc, I just wanted to know more specifically what areas
of the heart would just "fail" for that to occur? As I mentioned my Left Atria is 6.5cm (severely enlarged) and my
Left Ventricle is "mildly enlarged." Both Right Atria/Ventricle are normal and is all systolic function/walls, etc. on the
right side. My other 3 valves are also listed as fine. Only the Mild Mitral Valve Prolapse with Moderate to Severe
regurgitation is the concern along with the Afib. I am on Sotalol and Diltiazem and have only had a few episodes
of shortness of breath on these medications in 8 months. I don't know with those episodes of shortness of breath
if it was the Mitral Regurgitation or the AFIB.

Either way, i'm likely going to go ahead with the Mitral Valve Surgery as I don't want the regurgitation to get any worse.
Any thoughts on actually how badly a 6.5cm enlarged Left Atria actually is?

 

[Zoltania]

Sorry, I don't know anything about the severity of atrial enlargement.

I experienced something like what I described to you, with worsening regurgitation leading to shortness of breath, so that my surgery date was moved up. I had always thought that "shortness of breath" would feel like the effect of cardio intervals at the gym, but it felt quite different to me. I woke up one morning and just felt crappy and low-energy, as though walking across the room was a lot of work. I could tell something was really wrong and called a friend to take me to the E.R.

My friend had experience with a child who had asthma attacks, and she said the way I was speaking, with frequent breaths, reminded her of that. I didn't even realize I was speaking differently. In the E.R. they gave me I.V. Lasix to get rid of some of the fluid that I was retaining due to the heart failure, and I quickly felt much better; my friend said I was speaking better too. I had a cardiac catheterization the next day and surgery the day after that.

My guess is that, if your symptoms worsen like mine did, you will recognize it and be able to get the help you need. I know it's hard to "listen to your body" when anxiety is in the mix, but the really bad symptoms are likely to be unmistakable.

 

[dornole]

I have moderate mitral stenosis and and moderate regurgitation per my echo this May. Moderately enlarged left atrium normal left ventricle. But in 2022 echo said severely enlarged left atrium, mod regurgitation and mod-severe stenosis (?) the echo does have some margin of error.

I’m not sure what you are measuring with the 6.5 cm, none of my measurements of atrial size are in cm. ? Regardless they never seem to care at all about my atrium. It’s the left ventricle enlargement that makes them nervous. If I get that they’ll want me to go to surgery before it gets out of hand and the heart can’t remodel.

My understanding is my mitral valve issue is generally not a sudden killer. Even “Heart failure” is a degeneration, not like a heart attack. I had heart failure and pulmonary edema when my stenosis was severe. Post repair it’s gone.

Are you getting a repair or a replacement?

 

[V__]

Hello,

I'll try to provide comments below about particular details. My general impression is that you are overthinking your case instead of preparing for surgery. The said surgery likely has a very minimal risk and a huge benefit... right now. If you wait too late this opportunity will be gone and the outcome will be different.

That test came back as Severe Mitral Regurgitation, not "moderate to severe."

These are different stages. "Moderate to several" (aka "moderately severe") are one of them in the line up:
- no/"trivial" regurgitation
- mild
- moderate
- moderately-severe
- severe

If you don't get the surgery in time, the next stage is heart failure, with irreversible consequences.

My Atria is enlarged at 6.5cm and my Ejection Fraction is 51%. My Left Ventricle is moderately enlarged

The LV enlargement is one of the signs of the changes, that are hopefully reversible now. EF seems at the bottom part of the nominal range, if I recall correctly.

With this said, my current Cardiologist is referring me for surgery.

Then I think you should go for it. The doctor has more information about you than anybody here.

They think they have a good enough view on my echo where they can see the Mitral Valves not fully closing, causing the level of regurgitation I have, where I wouldn't need a TEE, but the valve specialist they referred me too will review the Echo themselves.

Must be a different system. My cardiologist had TEE done, since the surgeons need it for the precise planning. If the "valve specialist" is the cardio surgeon, I'd imagine they can still order TEE and/or other tests before the surgery, as necessary.

My questions are if there is a way to determine how bad my regurgitation is right now and what chance for Mortality there would be right now, as of today?

Echo test is the simplest way to get the information. I'm a bit unclear when your last test was. If it's recent enough, that's the info.

Are you asking about Mortality risk during surgery? Or how long do you have until kicking the bucket without one?

For the former, it's roughly 1%, depending on your exact details and complications. For the latter... I don't know why you want to know this. Roughly few years without symptoms. Much shorter with symptoms. Which I think may mean that you accumulate more risk by delaying the surgery for a month than actually having it. If I were you, I'd move aggressively scheduling one. In my case, I did.

but i've also read that heart failure can occur as well with Severe Regurgitation which is my main concern. Are there any specific tell-tale signs/symptoms from the Echo or otherwise that would determine the risk factor for mortality at the current time due to the Mitral Regurgitation?

AFAIK the exact progression to the cardiac failure is unpredictable. You may "just" find yourself in ER one day, in which case your longevity, well-being, and surgery risk will all be affected, for the worse. Even if they manage to save you.

My current EP reviewed my Echo's and said I have some time, so he didn't
make it seems as though it was extremely urgent.

Sure... But please note that "extremely urgent" for doctors means somebody is having a heart attack or equivalent. They are used to abnormalities, and your case is likely classified as "elective". But it's not optional - you need the surgery. The sooner you get it the better the outcome and less risk.

I just like to research as it is my heart and when you read things
like Mortality can occur within 1 year of Severe regurgitation, etc, I just wanted to know more specifically what areas
of the heart would just "fail" for that to occur?

I never cared to learn about this. Seems to me, avoiding the bad outcome is better than exploring its details.

HTH