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Primary Mitral Regurgitation — EECC MCQ

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ModerateValvular Heart DiseasePrimary Mitral RegurgitationEECC

A 55-year-old woman with severe primary (degenerative) mitral regurgitation (flail posterior leaflet, EROA 0.5 cm2, regurgitant volume 70 mL) is asymptomatic with LVEF 64% and LV end-systolic diameter of 42 mm. She has no pulmonary hypertension. The valve anatomy is favourable for repair. What is the recommended management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Mitral valve surgery (repair) at an experienced centre

Explanation lettering: C = shown as A · D = shown as C · E = shown as D · A = shown as E

The 2025 ESC/EACTS VHD Guidelines provide a Class I recommendation for mitral valve repair in asymptomatic patients with severe primary MR, preserved LV function, and high likelihood of durable repair (above 95%) at an experienced centre. The repair-friendly anatomy meets this threshold. Watchful waiting (A) risks irreversible LV dysfunction. TEER (C) is for high-surgical-risk patients. Medical therapy (D) does not alter natural history. Waiting for LV deterioration (E) is no longer the recommended approach.

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease