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Mitral Valve Prolapse with Severe MR — EECC MCQ

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ModerateValvular Heart DiseaseMitral Valve Prolapse with Severe MREECC

A 55-year-old woman presents with exertional dyspnoea and a mid-systolic click followed by a late systolic murmur. Echocardiography shows mitral valve prolapse (MVP) of the posterior leaflet with a flail P2 scallop, severe MR, LVEF 62%, LVESD 38 mm, and LVEDV 140 mL. Pulmonary artery systolic pressure is 55 mmHg. What is the recommended management?

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Correct answer: A — Mitral valve repair at an experienced centre

This patient has severe primary (degenerative) MR due to flail P2 with elevated pulmonary pressures (PASP >50 mmHg), which is a Class I indication for surgery even in the absence of symptoms. The 2025 ESC/EACTS VHD Guidelines recommend mitral valve repair over replacement for degenerative MR at experienced centres (surgical success rate >95% for posterior leaflet pathology). P2 prolapse/flail is the most amenable to surgical repair. TEER is reserved for patients with high/prohibitive surgical risk. Waiting for LVEF to decline further risks irreversible LV damage. Elevated PASP (>50 mmHg at rest) independently triggers the indication for surgery.

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