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MV Repair for Degenerative MR — RACP Adult Medicine MCQ

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ModerateCardiologyMV Repair for Degenerative MRRACP Adult Medicine

A 55-year-old man with degenerative mitral valve disease presents with severe mitral regurgitation (MR) due to posterior leaflet prolapse with flail segment. He is NYHA II with preserved LVEF (62%) and LVESD 38 mm. Echo shows no pulmonary hypertension. The valve appears repairable. What is the most appropriate intervention?

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Correct answer: A — Surgical mitral valve repair

Severe primary (degenerative) MR from posterior leaflet prolapse with preserved LV function is the ideal scenario for surgical mitral valve repair (not replacement). Repair preserves native valve, avoids anticoagulation, and has better long-term outcomes than MVR. Class I indication for surgery: symptomatic severe MR, or asymptomatic with LVEF <60% or LVESD ≥40 mm. This patient is symptomatic with preserved LV — proceed with repair.

Reference: CSANZ – 2024 – VHD; ESC 2021 VHD