Natural history of mitral regurgitation due to flail leaflets.

Mitral regurgitation can be treated successfully by valve replacement or repair with excellent relief of symptoms. Therefore, the presence of marked symptoms is a widely accepted indication for surgery. However, with this traditional approach, left ventricular dysfunction is a frequent postoperative complication, which carries a poor long-term prognosis''. The frequency and severity of this complication have led to the suggestion that surgery should be performed early in the course of the disease before severe symptoms occur''. Low operative mortality, excellent long-term survival and feasibility of valve repairs have made this approach clinically possible. Valve repair tends to preserve left ventricular function better than valve replacement, but it has not eliminated left ventricular dysfunction' and consequently is not a justification for delaying surgery but rather should be considered as an incentive for early surgery. However, early surgery is controversial, mainly because solid data on the natural course of medically treated mitral regurgitation are lacking.

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