Which management step is recommended for mitral regurgitation when the patient decompensates?

Which management step is recommended for mitral regurgitation when the patient decompensates?

• A. Beta-blocker therapy
• B. Surgical valve repair
• C. ACE inhibitors
• D. Diuretic therapy

Answer: (B)

Mitral regurgitation that has decompensated is driven by a structural valve problem, so the goal is to correct the valve itself rather than just manage symptoms. Medical therapy like diuretics to relieve congestion and afterload reduction with ACE inhibitors can stabilize a patient temporarily, but they don’t fix the regurgitant lesion. Surgical repair of the mitral valve directly eliminates the leak and offers the best long-term outcomes for survival and LV function, making it the recommended step in decompensation. If repair isn’t feasible, replacement is considered, but repair is preferred when possible because it preserves the native valve and function.

Mitral regurgitation that has decompensated is driven by a structural valve problem, so the goal is to correct the valve itself rather than just manage symptoms. Medical therapy like diuretics to relieve congestion and afterload reduction with ACE inhibitors can stabilize a patient temporarily, but they don’t fix the regurgitant lesion. Surgical repair of the mitral valve directly eliminates the leak and offers the best long-term outcomes for survival and LV function, making it the recommended step in decompensation. If repair isn’t feasible, replacement is considered, but repair is preferred when possible because it preserves the native valve and function.