Determining the stage of MR can help you and your doctor decide whether you may need surgical therapy, and, very importantly, to determine the optimal time for surgical therapy should you require it.
The Stages of Chronic Mitral RegurgitationCardiologists divide chronic MR into three "stages." Determining the stage of your MR helps your cardiologist to decide whether and when mitral valve surgery may be needed.
If you are in the "compensated stage" of MR, you will have no symptoms, and no significant enlargement of the left ventricle. People in this stage generally do not need valve surgery. Many patients with mild, chronic MR remain in the compensated stage throughout their lives.
If you are in the "transitional stage," you will be just beginning to develop symptoms of MR (usually, shortness of breath on exertion or reduced exercise tolerance) and/or enlargement of the left ventricle. Ideally, valve repair surgery should be performed during this transitional stage, when the risk of surgery is relatively low and the results relatively good.
Many experts believe once atrial fibrillation occurs in the presence of MR, especially if it is associated with dilation of the left atrium, that fact alone ought to indicate that the transitional stage has arrived, and therefore, that valve repair surgery ought to be at least considered.
If you are in the "decompensated stage," however, you will have significant symptoms of MR, as well as significant enlargement of the left ventricle. Essentially, the decompensated stage means that heart failure has already occurred. Once you are in the decompensated stage, valve repair surgery becomes quite risky, and may not produce an acceptable result.
The need to "catch" the transitional stage before it progresses to the decompensated stage explains why anyone with chronic MR needs routine, close medical monitoring. This monitoring in general consists of having periodic physical examinations and echocardiograms (which can help assess cardiac enlargement and the condition of the mitral valve), and for your doctor to carefully evaluate whether any new symptoms you may be experiencing are due to MR.
If you have MR, you should make sure your doctor is doing this appropriate monitoring -- and you yourself need to pay close attention to any signs of shortness of breath or a reduced ability to exert yourself.
Bonow, RO, Carabello, BA, Chatterjee, K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2008; 118:e523.
Vahanian, A, Baumgartner, H, Bax, J, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 2007; 28:230.