Napur, "permanent damage" means heart enlargement, and damage to other valves, as well.
I had MVP, which was ignored by my PCP, even when my legs were swollen and I was gasping for breath. I wound up in afib, with an 40% enlarged left atrium, subaortic stenosis, CHF, and damage to my aortic valve causing aortic insufficiency. All this took less than 6 months to develop, after a major respiratory illness .
I had to have a maze procedure as well as MVR. I nearly died shortly after surgery. I still have atrial enlargement, though it has remodeled some, and some subaortic stenosis. I'm looking at AVR before too long (it was almost NOW, but the TEE says not quite yet). Because of the surgery and maze procedure, I have complete heart block and a tendancy to ventricular arrhythmias, necessitating an ICD. I also have ventricular asynchrony.
I want my AVR done before any ventricular enlargement occurs (called really bad heart failure). ALL THAT's what we mean by permanent damage. I expect this will someday kill me.
That's why we recommend early surgery.
And yes, there's a family history: Dad had chronic afib, died of a clot post cancer surgery before he got back on coumadin. His sister, my Aunt, died of CHF, but no one ever told me her exact dx.