Treatment of Mitral Valve Prolapse with Symptomatic Severe Primary Mitral Regurgitation (Stage D)
This protocol addresses patients with mitral valve prolapse who have progressed to severe primary mitral regurgitation classified as Stage D — that is, symptomatic MR — and who do not carry high or prohibitive surgical risk. At this stage, symptoms are attributable to the MR itself, making intervention decisions central to management.
Clinical Scenario
Severe primary MR (Stage D) with symptoms attributable to mitral regurgitation, in a patient without high or prohibitive surgical risk. The evidence base for this situation is well-established: mitral valve intervention is recommended irrespective of left ventricular systolic function once symptomatic Stage D is reached.
Treatment Approach (partial overview)
The cornerstone of management is mitral valve intervention. The choice between repair and replacement depends on the anatomic cause and the likelihood of a durable result — the full protocol specifies the preferred approach for degenerative versus rheumatic etiologies, along with the role of specialised centre referral and the conditions under which each pathway applies.
References
DOI: 10.1161/CIR.0000000000000923
- In symptomatic patients with severe primary MR (Stage D), mitral valve intervention is recommended irrespective of LV systolic function.
- In patients with severe primary MR for whom surgery is indicated, mitral valve repair is recommended in preference to mitral valve replacement when the anatomic cause of MR is degenerative disease, if a successful and durable repair is possible.
- In symptomatic patients with severe primary MR attributable to rheumatic valve disease, mitral valve repair may be considered at a Comprehensive Valve Center by an experienced team when surgical treatment is indicated, if a durable and successful repair is likely.
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