Mitral valve prolapse
ICD-10 I34.1 · ICD-11 BB62

Treatment of Mitral Valve Prolapse with Severe Primary Mitral Regurgitation (Stage C1) — Asymptomatic with Normal Left Ventricular Ejection Fraction

This protocol addresses asymptomatic patients with mitral valve prolapse causing severe primary mitral regurgitation classified as Stage C1, where left ventricular systolic function remains preserved.

Clinical scenario: Severe primary mitral regurgitation (Stage C1), patient asymptomatic, with normal left ventricular ejection fraction (greater than 60%) and left ventricular end-systolic dimension below 40 mm.

Treatment approach

In this setting, mitral valve surgery — either repair or replacement — enters consideration. Notably, the indication can apply irrespective of the estimated probability of a successful and durable repair outcome. The complete protocol details the clinical criteria, thresholds, and decision pathway that determine when and how to proceed.

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References

DOI: 10.1161/CIR.0000000000000923

In asymptomatic patients with severe primary MR and normal LV systolic function (LVEF ≥60% and LVESD ≤40 mm) (Stage C1), mitral valve repair is reasonable when the likelihood of a successful and durable repair without residual MR is >95% with an expected mortality rate of <1%, when it can be performed at a Primary or Comprehensive Valve Center.

In asymptomatic patients with severe primary MR and normal LV systolic function (LVEF >60% and LVESD <40 mm) (Stage C1) but with a progressive increase in LV size or decrease in EF on ≥3 serial imaging studies, mitral valve surgery may be considered irrespective of the probability of a successful and durable repair.

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