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Severe Mitral Regurgitation — RACP Adult Medicine MCQ

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HardCardiologySevere Mitral RegurgitationRACP Adult Medicine

A 42-year-old man presents with a pansystolic murmur loudest at the apex radiating to the axilla. Echocardiography shows severe mitral regurgitation due to a flail posterior leaflet with LVEF 55% and LVESD 38 mm. He is asymptomatic and in sinus rhythm. What is the recommended management?

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Correct answer: C — Percutaneous MitraClip

For severe primary (organic) MR with a flail leaflet amenable to repair, early surgery is recommended even in asymptomatic patients with LVEF >60% and LVESD <40 mm if repair is feasible at an experienced centre with expected durability (ESC Class IIa). This patient's LVESD of 38 mm is approaching but has not reached the 40 mm surgical threshold. Current guidelines recommend surgery when LVESD reaches ≥40 mm, LVEF drops ≤60%, new AF occurs, or PASP rises >50 mmHg. Close surveillance with 6-monthly echo is appropriate if these criteria are not yet met.

Reference: CSANZ – 2022 – Valvular Heart Disease Guidelines; ESC – 2021 – VHD Guidelines