The AHA Guidelines and Scientific Statements Handbook

Chapter 18 Valvular Heart Disease

MV repair

Class I

Class IIa

Class IIa

Class IIa

Class I

EF > 0.30

ESD = 55 mm

EF < 0.30 and/or

ESD > 55 mm

New onset AF?

Pulmonary HT?

MV repair

likely?*

Clinical evaluation + Echo

Chronic severe mitral regurgitation

Reevaluation

Symptoms?

No

Normal LV funciton

EF > 0.60

ESD <40

Medical therapy

LV function?

Yes

Yes*

Yes

No No

No

Clinical eval

every

6 mos.

Echo every

6 Mos

LV dysfunction

EF = 0.60 and/or

ESD = 40 mm

MV repair

If not possible,

MVR

Chordal preservation

likely?

Yes

LV function?

Fig. 18.4 Management strategy for patients with chronic severe mitral regurgitation.

• Mitral valve repair may be performed in asymptomatic patients with normal LV function if performed by an experienced surgical team and the likelihood of
  successful MV repair is greater than 90%.
  AF, atrial fi brillation; EF, ejection fraction; ESD, end-systolic dimension; HT, hypertension; MV, mitral valve; MVR, mitral valve repair.

3 Mitral valve surgery is reasonable for asymptom-
atic patients with chronic severe MR,* preserved
LV function, and pulmonary hypertension
(pulmonary artery systolic pressure greater than
50 mm Hg at rest or greater than 60 mm Hg
with exercise). (Level of Evidence: C) ESC

recommendation, IIa (C) for resting measurement

≥50 mm Hg only

4 Mitral valve surgery is reasonable for patients

with chronic severe MR* due to a primary abnor-

mality of the mitral apparatus and NYHA functional

class III–IV symptoms and severe LV dysfunction