Treatment Options for Mitral Regurgitation

A 72-year-old female patient presents with a 2-month history of increasing shortness of breath and orthopnea. She is unable to walk for than a few steps before becoming dyspneic. Her comorbidities include moderate chronic obstructive pulmonary disease, asymptomatic 70% carotid stenosis, and severe rheumatoid arthritis involving the bilateral knees and hips that results in limited mobility and requires the patient to use a cane to ambulate. Physical examination reveals a 3/6 holosystolic murmur at the apex with an early diastolic filling sound and an accentuated pulmonic component of the second heart sound. A transthoracic and transesophageal echocardiogram are performed (Figure 1) that demonstrate severe mitral regurgitation (MR) due to a flail A2 segment of the mitral valve and an ejection fraction of 70%. On frailty evaluation, the patient meets two of the four criteria (reduced grip strength and 5 meter walk speed). The Society of Thoracic Surgeons risk score is 6% for mitral valve repair and 7% for replacement.

Figure 1

Figure 1
The top two images show a two-dimensional transesophageal echocardiogram demonstrating a flail A2 segment with resulting severe mitral valve regurgitation. The bottom two images show a three-dimensional transesophageal echocardiogram demonstrating a flail A2 segment of the mitral valve with corresponding central jet of MR.

Which of the following statements is correct regarding treatment of this patient's mitral valve regurgitation?

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