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Mitral valve prolapse, taking painkillers for headache, no palpitation or breathing difficulties. Is this the right time to have surgery?

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Cardiac Surgeon
Practicing since : 1972
Answered : 9 Questions

I am a 36-year-old male (181cm, 78kg, non-smoker,and non-drinker) and I was diagnosed with Mitral Valve Prolapse 4 years ago. I am currently asymptomatic and don’t have any palpitations or breathing difficulties. However, I have not really exercised for a duration of 6 months up until last month so my current fitness level is on the low side but getting better: my exercise regime varies throughout the year from good (5-6 times a week for 6-7 months) to poor (almost none during the remainder of the year).

I’ve seen my cardiologist for the biannual check up in February 2012 and based on the echo results my cardiologist told me that I will need surgery and referred me to a cardiac surgeon. I have not seen the surgeon yet but I received a message that I’m on the waiting list for the surgery. While I’m waiting to see him, I have asked my cardiologist to refer me to another cardiac surgeon for a second opinion.

I don’t have any other medical illnesses and am not on any medications. I take painkillers for headaches/migraines once every couple of weeks or so. I take antihistamines during springtime for allergies.

My questions are:

1. Based on the recent report, is this the right time for me to have surgery? (Is it better to have the surgery sooner than later?)
2. Considering my condition, is mitral valve repair a valid option? (I understand this may not be answered without
3. If mitral valve repair is a valid option for me, how many similar mitral valve repair surgeries should a surgeon have conducted before he/she is considered to be an expert in this area (50, 100, 200,etc.)? What is the repair success rate I should look for in a surgeon? I’m a Turkish/New Zealand citizen so I can have this operation in either country if surgical expertise in Auckland/NZ is considered on the low side purely due to the limited volume of mitral repair surgeries conducted here.
4. If mitral valve replacement is the only available option, what kind of valve (mechanical/tissue) would you recommend to patients in similar conditions?
5. What kind of questions should I be asking the surgeon?
6. I eat a healthy diet but I drink 2-3 double shots of espresso every day. Should I decrease my caffeine intake?
7. I currently exercise using the cross trainer 5 times a week for 40 min in each session, keeping my heart rate between 120-150 during exercise. Is this ok? Is there anything I should avoid?

Hope the above is clear. Thanks for your response in advance.
Posted Mon, 21 May 2012 in Valvular Heart Disease
Answered by Dr. Joan F. Tryzelaar 12 hours later

Let me answer all your questions as a summary format.

The decision for surgery depends on the degree of valve malfunction and the enclosed information confirms severe leakage of your mitral valve with otherwise well preserved heart function. The anatomy reported is such that I can indeed confirm valve repair would have a very high likelihood of success.

At your age I'd absolutely recommend a repair over replacement. Most modern surgeons are capable, but like in any other profession, there are some who will be better at it than others. During my travels I have found some of the best surgeons in the most unlikely places, let alone in a country like New Zealand where all physicians would be trained to western European and American standards. I would expect you have a number of local experts, and you should ask them about their specific results. In the US some centers now offer a robotic valve repair depending on the anatomy of the valve and you should ask whether such an option is available.

Regarding your general condition, I see no particular specific risks. Every cardiac operation has risks & complications associated with it that can occur in the best of hospitals, your risk being relatively low. You should also know that the best operation can be complicated by poor post-operative care, and some surgeons don't supervise this much, leaving that to others whose credentials are usually not discussed: Ask your cardiac surgeon specifically who would be taking care of you during the post operative period. Caffeine intake and exercise are fine since you do not complain about these. I think the caffeine intake does not alter the decision to operate.


If your valve is failing, repair is almost always the best option.

Your general health appears to make you an excellent candidate (not knowing details).

Hope this helps,

Dr T

Above answer was peer-reviewed by
Follow-up: Mitral valve prolapse, taking painkillers for headache, no palpitation or breathing difficulties. Is this the right time to have surgery? 8 hours later
Dear Dr Tryzelaar,

Firstly, thanks for your response.

You have noted, "...I would expect you have a number of local experts, and you should ask them about their specific results..."

I am hoping to talk to the surgeons regarding my case over the coming weeks. I'll be asking the number of MV repair surgeries they performed and their success rate.
- In your opinion, what constitutes a success rate: is it just the number of successful surgeries or should that information include the number of patients requiring re-repair / replace after 1, 5, etc. years.
- Should I also ask about all other (non-MV repair) cardiac surgeries they performed? In my case, is it more important to choose a surgeon that has done more MV repairs over another one who has done more cardiac surgeries in total but fewer MV repairs?
- The letter from cardiosurgical conference indicates there is a "high" likelihood of repair in my case. Some of the literature is advising patients to ask surgeons for repair probability close to 100%. If one surgeon tells me, there is 98% chance of repair and the other one says 85% or "high", I do not feel if I'm best placed to differentiate between these assessments. For me, this feels like a subjective assessment of a surgeon's own capability therefore it won’t be a simple case of comparing apples to apples. Do you have any suggestions for me regarding this matter?

Thanks again for your feedback, greatly appreciated.

Here is hypothetical (perhaps a far fetched) question. During a surgery, is it possible that a MV repair will need to be switched to a MV replace for some reason?

Answered by Dr. Joan F. Tryzelaar 12 hours later

Mitral Valve (MV) repairs are amongst the most complicated cardiac procedures. Any surgeon who performs them regularly is going to be good at it, but needs enough "patient supply", a factor that is not under his control. That is why this procedure is more often performed at a major medical center that usually has many more patients than a local hospital.

Occasionally, a conversion to MV replacement may be necessary, but I doubt your case would be one of those.

I'd be concerned about a surgeon who has a high conversion rate. Based on the facts you supplied, I'd be in the group of surgeons who estimate a repair probability close to 100% and probably look for another surgeon if it was estimated at a lower rate.

Hope this helps. Thanks once again for posting your query to me.
Please accept the answer and close the discussion if all your queries are answered.

Dr T
Above answer was peer-reviewed by
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