{"id":4944,"date":"2024-09-30T20:34:54","date_gmt":"2024-09-30T20:34:54","guid":{"rendered":"https:\/\/www.heart-valve-surgery.com\/learning\/?page_id=4944"},"modified":"2024-10-01T17:47:18","modified_gmt":"2024-10-01T17:47:18","slug":"risks-benefits-asymptomatic-mitral-valve","status":"publish","type":"page","link":"https:\/\/www.heart-valve-surgery.com\/learning\/risks-benefits-asymptomatic-mitral-valve\/","title":{"rendered":"Surgeon Q&#038;A: Risks Versus Benefits of Asymptomatic Mitral Valve Surgery"},"content":{"rendered":"<p>When the mitral valve doesn\u2019t close properly due to mitral valve prolapse (see picture below), it allows the abnormal backward flow of blood from the left ventricle to the left atrium. This condition is called <a href=\"https:\/\/www.heart-valve-surgery.com\/mitral-valve-regurgitation-symptoms-leaking.php\">mitral valve regurgitation<\/a> (MR), a leaking valve or mitral insufficiency. It is the <a href=\"https:\/\/www.heart-valve-surgery.com\/heart-surgery-blog\/2023\/04\/06\/what-is-mitral-valve-disease\/\">most common heart valve abnormality<\/a> &#8211; affecting over two percent of the population &#8211; and its prevalence increases with age.<\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-4952 aligncenter\" src=\"https:\/\/www.heart-valve-surgery.com\/learning\/..\/Images\/mitral-valve-prolapse-scientific.jpg\" alt=\"Mitral Valve Prolapse\" width=\"500\" height=\"417\" \/>Mitral Valve Prolapse<\/p>\n<p>&nbsp;<\/p>\n<p>The left ventricle can often adapt to the abnormal backflow across the mitral valve and symptoms may not be apparent for many years. Many asymptomatic patients don\u2019t even know they have a leaky mitral valve until a doctor listens to their heart during a routine exam and hears a murmur. If the regurgitation progresses, the heart\u2019s structure can change and make it difficult to regain normal cardiac function.<\/p>\n<p>But if there aren\u2019t symptoms, how do patients know when mitral regurgitation is becoming more severe, putting them at risk for further complications? We recently received a question from Erica on this specific topic, who asked: &#8220;What is the latest opinion on the risk versus benefit of watchful waiting for mitral valve repair versus proactive surgery if a patient is asymptomatic but has severe regurgitation?\u201d<\/p>\n<p>To answer Erica\u2019s question, we met with <a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Junaid-Khan-Oakland-California.php\">Dr. Junaid Khan<\/a>, a leading cardiac surgeon at Alta Bates Summit in Oakland. Dr. Khan has performed thousands of heart valve procedures, and mitral valve repair is among his many specialties.<\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/NeKdNmENq-M?rel=0\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n<p>&nbsp;<\/p>\n<h2>Key Learnings About Watchful Waiting Versus Surgery<\/h2>\n<p>Here are important insights shared by Dr. Khan in his response to Erica:<\/p>\n<ul>\n<li><strong>Patients, primary care providers, and cardiologists commonly ask Erica\u2019s question. <\/strong> Khan said, \u201cErica, that is a fantastic question. I will tell you it\u2019s probably one of the most common questions I get asked, not only from patients but from their primary care providers and even some outside cardiologists. The first thing I always tell patients is I don\u2019t necessarily believe them when they tell me they\u2019re truly asymptomatic.\u201d Dr. Khan explained that people\u2019s symptoms can be varied. \u201cI\u2019ll give you an example of a patient I operated on a couple of weeks ago. He used to walk 18 holes of golf. Now, he takes a cart. He says he\u2019s asymptomatic, but really, that is his symptom. You really want to be honest with yourself about the symptoms. Now, if you are truly asymptomatic, there are some gold standard studies published in the New England Journal that talk about asymptomatic patients.\u201d<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>A quantitative assessment of mitral regurgitation is essential. <\/strong>\u201cEven today, you have a one in five chance of dying if you\u2019re asymptomatic with severe mitral regurgitation,\u201d said Dr. Khan. \u201cThe most important thing you can do is make sure you have a quantitative assessment of your mitral regurgitation.\u201d Dr. Khan explained that severe mitral regurgitation can have a different meaning for certain people, but a <a href=\"https:\/\/www.heart-valve-surgery.com\/echocardiogram-stress-doppler-tee.php\">transesophageal echocardiogram (TEE)<\/a> can give that quantitative assessment, or measurement of mitral regurgitation, by assigning it a specific number called an <a href=\"https:\/\/www.omnicalculator.com\/health\/eroa\">Effective Regurgitant Orifice<\/a>, or ERO. Dr. Khan said, \u201cIf that number is greater than 40, I know the survival advantage today, in my hands and particularly when we can do it minimally invasively, is much better to have surgery sooner rather than later.\u201d<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-4948 size-full aligncenter\" src=\"https:\/\/www.heart-valve-surgery.com\/learning\/..\/Images\/dr-khan-asymptomatic-mitral-regurgitation-key-points.jpg\" alt=\"Dr. Khan's Key Points about Asymptomatic Mitral Regurgitation\" width=\"650\" height=\"363\" \/><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong>What would be Dr. Khan\u2019s recommendation for Erica? <\/strong>\u201cI think, Erica, you need to define what severe mitral regurgitation means,\u201d said Dr. Khan. \u201cIf you haven\u2019t had a transesophageal echocardiogram, you\u2019ll want to get that, and you want to know what the effective regurgitant orifice, ERO, is. If it\u2019s greater than 40, then you should see a surgeon who can do this minimally invasively for a survival advantage.\u201d<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h1>Thanks Dr. Khan and Alta Bates Summit!<\/h1>\n<p>On behalf of Erica and our HeartValveSurgery.com patients worldwide, thank you to <a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Junaid-Khan-Oakland-California.php\">Dr. Junaid Khan<\/a> for sharing your expert insight into the risk versus benefit of mitral valve surgery for asymptomatic mitral regurgitation patients! We would also like to thank Dr. Khan\u2019s <a href=\"https:\/\/www.heart-valve-surgery.com\/hospital\/alta-bates-summit-valve-center\">Alta Bates Summit Medical Center<\/a> team for taking great care of our heart valve patients!<\/p>\n<p>Related links:<\/p>\n<ul>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/learning\/mitral-valve-re-replacement\/\">Surgeon Q&amp;A: Is Minimally Invasive Mitral Valve Re-Replacement Possible?<\/a><\/li>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/learning\/asymptomatic-degenerative-mitral-regurgitation\/\">Cardiologist Insights: Asymptomatic Mitral Valve Regurgitation<\/a><\/li>\n<li><a href=\"https:\/\/www.heart-valve-surgery.com\/surgeons\/dr-Junaid-Khan-Oakland-California.php\">Explore Dr. Khan\u2019s Interactive Surgeon Profile with 30+ Patient Reviews<\/a><\/li>\n<\/ul>\n<p>Keep on tickin!<br \/>\nAdam<\/p>\n<p>P.S. For the deaf and hard-of-hearing members of our community, I have provided a written transcript of this interview with Dr. Khan below.<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":4,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"cms.php","meta":{"_acf_changed":false,"footnotes":""},"categories":[12],"class_list":["post-4944","page","type-page","status-publish","hentry","category-mitral-regurgitation"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/4944","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/comments?post=4944"}],"version-history":[{"count":16,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/4944\/revisions"}],"predecessor-version":[{"id":4965,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/pages\/4944\/revisions\/4965"}],"wp:attachment":[{"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/media?parent=4944"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.heart-valve-surgery.com\/learning\/wp-json\/wp\/v2\/categories?post=4944"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}