Mitral Valve Prolapse/Regurg & AFIB Questions

I've done a lot of reading on AFIB and there are many things that "can" cause it such as obesity, sedentary lifestyle, alcohol abuse, smoking, and some type of heart conditions. In my case I did drink alcohol much more than I should of and have gained a lot of weight so one or maybe both of those factors caused it. I also became more Sedentary over the years and i've been working on all of these things, most specifically, the last few months and I definitely, at least, "feel better." With that said, I was diagnosed via an echocardiogram about 8 months ago with AFIB. At the same time an echocardiogram was done and I was told I have Mitral Valve Prolapse and Mitral Valve Regurgitation.

What is interesting about this is the two hospital cardiologists (one of which was an EP) were very non-chalant when I asked questions about the Mitral Valve report from the ECHO. The Hospital PCP is the one who mentioned this to me initially, so I brought it to the cardiologist/EP's as when they came in to discuss AFIB and medication/cardioversion and Ablation they mentioned nothing about the Mitral Valve. After reading online and reading my Echocardiogram, it doesn't "sound" good from what I'm reading, but I can't imagine that a hospital cardiologist and EP would almost blow it off. I asked about it a 2nd time before Discharge and the EP actually waved his hand and said don't worry about that, worry about getting the AFIB in check. Before I was discharged I spoke to the hospital PCP who brought told me about this and he said it is something that needs to be monitored to ensure it doesn't get worse and at some point in time it may need to be "tightened."

I have copied a good portion of my echocardiogram here in this thread. The reason I am mentioning all of this is because one of the things I read says Mitral valve issues CAN cause AFIB and i'm thinking if I were at some point going to get an ablation, why would I get an ablation if I have lingering Mitral Valve issues? Can someone help explain this to me and what to make of the echocardiogram? Thank you in advance.


Ejection Fraction by Simpson's Method: 55%

Left Ventricle
Mild left ventricular enlargement. Moderate concentric left ventricular
hypertrophy. Normal left ventricular systolic function. Ejection Fraction by
Simpson's Method is 55%. Diastolic function cannot be assessed secondary to
patient being in atrial fibrillation. Normal left ventricular wall motion.

Right Ventricle
Mild right ventricular enlargement. Normal right ventricular systolic
function.

Atria
Severe left atrial enlargement. Severe right atrial enlargement. The RA
volume is 63ml.

Mitral Valve
There is mild mitral valve prolapse. Moderate to severe mitral regurgitation.
Flow reversal noted in pulmonary veins consistent with significant mitral
regurgitation. The MR jet is eccentric.

Tricuspid Valve
Tricuspid valve is normal in structure. Trace tricuspid regurgitation.

Aortic Valve
Normal aortic valve structure. No aortic regurgitation is present.

Pulmonic Valve
The pulmonic valve is not well visualized.

Great Vessels

Borderline aortic root dilatation. The IVC is normal size and collapses,
suggesting normal right atrial pressures. The RAP is 3mmHg.

Pericardium/Pleural
No pericardial effusion. No pleural effusion.



Edited 1 time(s). Last edit at 06/28/2023 07:10PM by cornerbax.

Mild mitral valve prolapse is common and not a dire emergency, so that's why the PCP simply said it needs to be monitored and the cardiologists weren't alarmed. You shouldn't be alarmed either. I would agree that the afib should be your priority right now, not the mitral valve. Just find a good cardiologist to follow up who can monitor you over the coming years and deal with the afib first with a good EP. Shouldn't be hard to find an EP who will do both.

Nothing glaring sticks out at you on the echo? On both Echo's the verbiage used is minor or moderate regarding the Mitral Valve, but the one area states severe in the wording. "Moderate to severe mitral regurgitation.Flow reversal noted in pulmonary veins consistent with significant mitral
regurgitation. The MR jet is eccentric."

That too, seems common/typical? And the Severe Left and Right Atrial enlargement? What are your thoughts on that?

Actually, all the stats I copied and pasted were from the first Echo. The Echo that was done end of January (5 months ago) states this:

Atria
The left atrium is severely dilated. Mild right atrial enlargement. The
interatrial septum appears intact with no evidence for an atrial septal
defect.

Mitral Valve
Mildly thickened mitral valve. Prolapse of the posterior mitral leaflet(s).

There is mild mitral valve prolapse. Moderate mitral regurgitation. The
mitral regurgitant jet is eccentrically directed. Flow reversal noted in
pulmonary veins consistent with significant mitral regurgitation.

The wording of the most recent Echo doesn't state "Severe" anywhere for the Mitral Valve, and neither does it for the Atria. Does this seem correct? 8 months ago the echo says Severe Atrial left and right enlargement and 3 months later doesn't say severe anywhere?
It's definitely confusing and concerning.

What i'm concerned about is if I do get an ablation and the Mitral Valve issues are still present, wouldn't that adversely affect the ablation and still allow AFIB to be present?



Edited 2 time(s). Last edit at 06/28/2023 09:08PM by cornerbax.

No, nothing glaring sticks out on that report. It's not as significant or serious as you think.

The severe atrial enlargement is almost certainly due to the afib, and all that does is make afib more likely to continue. "Afib begets afib" is the old saying. That's why dealing with the afib is the priority.

As for getting an ablation with the mitral valve issues, you've got to go back to the fact that the mitral prolapse is mild and it's unlikely to cause afib. You could easily spend the next 10 years with the same degree of prolapse and not need to do anything about it. I think you overestimate the seriousness of your valve issue.

Quote

I have copied a good portion of my echocardiogram here in this thread. The reason I am mentioning all of this is because one of the things I read says Mitral valve issues CAN cause AFIB and i'm thinking if I were at some point going to get an ablation, why would I get an ablation if I have lingering Mitral Valve issues? Can someone help explain this to me and what to make of the echocardiogram? Thank you in advance.

I have a lot of experience with this issue. I was told that I had mild mitral valve prolapse and mild regurgitation about 30 years ago and told to have it monitored regularly with echocardiograms—which I have. A couple of years ago I approached Dr. Natale for an ablation and sent my medical records. He asked for a new echo and the report now said, “severe mitral valve regurgitation.” Dr. Natale said that this needed to be repaired before an ablation. I got several opinions and the consensus was that a MitraClip would be a good choice for me. It is placed transcatheter so no open heart surgery. My echoes now show trace mitral valve regurgitation and I went ahead with an ablation last November.

Dr. Natale warned me that I was likely to need an extensive ablation because of my history of mitral valve disease—and indeed I was a complex case and my ablation was extensive. My local EP had brushed off an earlier echo that reported “moderate to severe regurgitation”—but Dr. Natale spotted that and called for a new echo. You might want to do some googling for studies on the relationship between severe regurgitation and Afib. I saw one a while back and posted a link to it but I do not have time to hunt it down right now.

I see that your report says “moderate to severe mitral valve regurgitation.” I didn’t see your pulmonary pressure but look for it as it might be elevated with significant regurgitation. You are right—all this needs more consideration.



Edited 1 time(s). Last edit at 06/28/2023 09:32PM by Daisy.

Wow, that was a reading roller coaster. I read in order of Carey's response which was non-chalant regarding the Mitral Valve and focused on the AFIB. Than to read Daisy's experience puts me right back to square one. I think there's great info in both responses and again, I appreciate it. What is interesting to me is not only did the hospital cardiologist not even mention anything about the Mitral Valve readings, but either did the hospital EP, or the EP I initially saw when I was released from the hospital. I had some other concerns with the outpatient EP and since I fortunately have great health insurance, I decided to research and found an EP with Cedars-Sinai and who is part of the EP program they have there. I have only had conference calls with this EP as well as his Nurse Practitioner, which is normal these days as Carey stated.

I simply sent them all of my hospital ecg's, echocardiograms, doctor's notes, etc, and he reviewed them. I will say what is interesting is HE TOO did not say a SINGLE WORD about the Mitral Valve, and oddly enough I haven't asked him about it, but it can't hurt to ask him on the next Zoom call which is in a few months. My only concern is the word "severe" in some of the Verbiage. I do remember when I was in the hospital they really state anything and everything that can cause an issue even if it isn't part of the issue. I asked my PCP about this and he said they always use caution for legalities and the such and even if something is extremely remote, they make it more drawn out in the event there is an issue.

With that said, I don't know why the word "SEVERE" would be used at all. Minor to me is minor, moderate is moderate, severe is severe. It is very peculiar, however, that a combined total of FOUR cardiologits/EP's didn't make much of this. With Daisy's issue, it sounds like it was just one prior cardiologist/EP that made an incorrect assessment of the Mitral Valve issues. Maybe as Carey stated there isn't much to it...at least now. But from Daisy's experience, it can't hurt to ask direct questions to my current Cedars EP.

Anybody have any other thoughts on this with the verbiage of "Severe" used even though it's stated Moderate to Severe?

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cornerbax
But from Daisy's experience, it can't hurt to ask direct questions to my current Cedars EP. Anybody have any other thoughts on this with the verbiage of "Severe" used even though it's stated Moderate to Severe?

When Dr. Natale called for a new echo and the report said severe regurgitation, my local EP thought that the best approach was a surgical repair. I researched the best places for mitral valve repair and chose Cedars Sinai as it was one of the top three and closest to me. I had an appointment with the then head of cardio thoracic surgery, Dr. Alfredo Trento, who explained that the level of regurgitation was a judgment call, not an exact science and that one cardiologist might say moderate to severe and another say severe. I had brought with me a locally done transesophogeal echocardiogram which he said was not well done and he did another echo. His recommendation was the MitraClip which I had done locally as there was an interventional cardiologist who specialized in playing them in my city. But Dr. Trento’s full recommendation was to get the MitraClip and then go back to Dr. Natale for an Ablation—I found this especially interesting as it was coming from a cardio thoracic surgeon who specialized in surgical repairs—and he did agree that the mitral valve regurgitation needed to be fixed before an ablation.

My local interventional cardiologist also reiterated that moderate to severe and severe were not all that different as there were things that might affect the level of backflow at the time of the echo and that it was a judgment call. I my case he also felt that I needed intervention and that my anatomy was well suited to the MitraClip. I your case it says that the mitral valve prolapse is mild and that may catch the attention more than the moderate to severe regurgitation.

Looks like we both are with Cedars-Sinai. It sounds like you had a great experience so that is great to hear. My Cedars EP, as I stated also didn't mention a word to me about anything to do with the mitral valve so as I said on our next meeting it will be the first thing I bring up and I'll ask his professional opinion on it.

You mentioned that the word "mild" was used in for my mitral valve prolapse which might catch MORE attention? Wouldn't mild catch LESS attention or are you saying because the prolapse is listed is Mild while the regurg is listed as moderate to severe there is a conflict there? Are either of the two.... Prolapse or regurgitation more significant than the other?

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cornerbax
You mentioned that the word "mild" was used in for my mitral valve prolapse which might catch MORE attention? Wouldn't mild catch LESS attention or are you saying because the prolapse is listed is Mild while the regurg is listed as moderate to severe there is a conflict there? Are either of the two.... Prolapse or regurgitation more significant than the other?

Just that with a quick reading someone might see “mild prolapse” and focus on the word mild and not take in that the regurgitation was moderate to severe. The level of regurgitation is more significant I think as this is what could cause dysfunction as the blood jets backwards. As I remember, it could also lead to more problems in the left atrium.

Here is the article I mentioned in my last post: “Atrial Fibrillation and Mitral Valve Prolapse: Time to Intervene?” [www.ncbi.nlm.nih.gov]

“Atrial fibrillation (AF) is a common sequela of degenerative mitral regurgitation (DMR) and is frequently present in patients referred for surgery for DMR.(1) DMR may lead to the development of AF via left atrial (LA) volume and pressure overload, progressive atrial fibrosis, LA enlargement, and electroanatomic remodeling.(2–5) Progressive LA enlargement and remodeling – hallmarks of long-standing DMR – promote AF substrate by affecting cell coupling, altering conduction velocity, and promoting reentry.(6)”



Edited 2 time(s). Last edit at 06/29/2023 04:15PM by Daisy.

I just read the article you linked and it's very informative. I don't understand all of the lingo but understand the main points. That being said, if 4 cardiologists/EPs all scanned through my echo and missed the moderate to Severe Mitral valve regurgitation....I'm gonna need a 5th!

I just did more research and read (from the Mayo Clinic) that in SEVERE mitral valve regurgitation the left Ventricle gets bigger as to the heart having to pump blood much harder through to the entire body. After reading this, I went back to my echo and it states my left (and right) ventricles are of mild enlargement and the left Ventricle even has normal systolic function. If I understand what Mayo clinic is saying shouldn't my left Ventricle be SEVERELY enlarged also due to the Severe Mitral valve Regurgitation if what I have is actually SEVERE?



Edited 1 time(s). Last edit at 06/29/2023 04:47PM by cornerbax.

My wake-up call on severe regurgitation was Dr. Natale warning me that this history was likely to point to a more extensive ablation with a good chance that I would need a touchup later. After reading the article I linked, I’d guess that the regurgitation increased fibrosis and that exacerbated the Afib/flutter. He did find moderate fibrosis and also needed to ablate-isolate the left atrial appendage, which is not typical for an index ablation. You might consider showing this article to your EP as it is raising the question about earlier intervention for mitral valve regurgitation in patients with Afib.

Sorry, I don’t know enough to comment on the status of the left ventricle but do watch your pulmonary pressure. My ventricals were normal size but the atria were both mildly dilated.

When you say pulmonary pressure is this from the echo cardiogram as well? I will definitely discuss in detail all of this with my EP. In addition, I've done lots of reading here and read Carey's article on an expert EP that does primarily bi-atrial ablations.

I've read too many horror stories about endless ablations and regardless of the diagnoses, I'd live as healthy a lifestyle I possibly can before I'd get caught up in endless ablations. There's no guarantees on anything in life but as Carey has stated many times... It's up to you to find a top notch EP who does little else but bi-atrial ablations. I will ask ask my current EP if he falls into this category and if not will ask who at Cedars does.

Thanks again for all of the helpful info. There is still much more to get answers too and consider at this point in time.

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cornerbax
When you say pulmonary pressure is this from the echo cardiogram as well? I will definitely discuss in detail all of this with my EP.

Yes, you should find this on your echocardiogram report. Mine went down after the mitral valve repair.

I just checked my two echos and don't see anything about pulmonary pressure. Should I be looking for some abbreviation of something. There are several formulas on the echos.



Edited 1 time(s). Last edit at 03/07/2024 01:46AM by cornerbax.

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cornerbax
Should I be looking for some abbreviation of something. There are several formulas on the echos.

Look for Pulmonary Arteries (PA) Systolic Pressure, or a notation of Pulmonary hypertension.

interesting, I just went over my entire Echo and nothing of any of those you listed are there. I will ask my EP on this. The only thing I see with Pulmonary at all is:

Pulmonic Valve
The pulmonic valve morphology is within normal limits. There is no pulmonic
valvular stenosis. Trace pulmonic regurgitation


I will definitely ask my EP.

I don’t know your gender but you maybe in really good hands at Cedar Sinai Women’s heart (Barbara Streisand center). They have excellent general cardiologists who don’t just write you off but will spend about 45-60 minutes with you. They take both men and women as patients but are also specialists of small vessel disease (micro vascular disease) and the effects of chemo to one!s heart. That’s how I found out about them in 2006 plus they managed my mitral valve prolapse care as well. Top notch caring cardiologists. Dr Noel Baily Merz is their director.

Who was their EP they suggested? Dr Michael Shehata, EP, is part of their group.. just curious because they like an umbrella package in their practice to fulfill all their patients needs.

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cornerbax
Wow, that was a reading roller coaster. I read in order of Carey's response which was non-chalant regarding the Mitral Valve and focused on the AFIB. Than to read Daisy's experience puts me right back to square one. I think there's great info in both responses and again, I appreciate it. What is interesting to me is not only did the hospital cardiologist not even mention anything about the Mitral Valve readings, but either did the hospital EP, or the EP I initially saw when I was released from the hospital. I had some other concerns with the outpatient EP and since I fortunately have great health insurance, I decided to research and found an EP with Cedars-Sinai and who is part of the EP program they have there. I have only had conference calls with this EP as well as his Nurse Practitioner, which is normal these days as Carey stated.

I simply sent them all of my hospital ecg's, echocardiograms, doctor's notes, etc, and he reviewed them. I will say what is interesting is HE TOO did not say a SINGLE WORD about the Mitral Valve, and oddly enough I haven't asked him about it, but it can't hurt to ask him on the next Zoom call which is in a few months. My only concern is the word "severe" in some of the Verbiage. I do remember when I was in the hospital they really state anything and everything that can cause an issue even if it isn't part of the issue. I asked my PCP about this and he said they always use caution for legalities and the such and even if something is extremely remote, they make it more drawn out in the event there is an issue.

With that said, I don't know why the word "SEVERE" would be used at all. Minor to me is minor, moderate is moderate, severe is severe. It is very peculiar, however, that a combined total of FOUR cardiologits/EP's didn't make much of this. With Daisy's issue, it sounds like it was just one prior cardiologist/EP that made an incorrect assessment of the Mitral Valve issues. Maybe as Carey stated there isn't much to it...at least now. But from Daisy's experience, it can't hurt to ask direct questions to my current Cedars EP.

Anybody have any other thoughts on this with the verbiage of "Severe" used even though it's stated Moderate to Severe?

Hey Susan, more great info thank you., I am 48 years old and a Male. You nailed it...you are good like most here are....indeed it is Dr. Shehata. I sent him (via his Nurse Practitioner) all of my info on our initial call months ago. The only thing he mentioned was AFIB, AFIB, AFIB and the Atria being enlarged because of AFIB AFIB AFIB....he didn't mention a peep regarding the Mitral Valve. He said the sooner I get into Normal Sinus Rhythm the better. On sotalol and Diltiazem I've had zero "episodes" just a resting heart rate over 100bpm which would be ideal to be lower.

I didn't directly ask Dr. Shehata about the Mitral Valve because FOUR other Doctor's dismissed, it. Dr. Shehata reviewed all my medical records and ONLY mentioned the Afib and the somewhat enlarged Atria. But as I said, I didn't have ONE, I had FOUR doctor's essentially dismiss it. 2 hospital Cardiologists, the Hospital EP and the hospital PCP. From what I recently found out the AFIB could also be contributing to the Mitral Valve issue getting worse as the strain on it is greater because of the AFIB. Regardless, I still want/need to know definitively on my Mitral Valve before proceeding with any possible Ablation. It's so difficult to find good info on the differences of Mild/Moderate or even Severe.

Are there any specific symptoms one might have with SEVERE they would not have with Mild or Moderate? As I mentioned, I have NEVER had any chest pain, i've NEVER been Dizzy (with Afib/Mitral Valve or anything else), i've never passed out, i've only been Short of breath like being out of shape which I am. I have been diligently working on losing weight (which I have) and cutting out alcohol. The worst symptoms I ever had were when I had the severe reaction to Flecainide and Propafenone.

At this point I will get definitively clarity on the Mitral Valve and go from there.



Edited 1 time(s). Last edit at 07/03/2023 07:00PM by cornerbax.

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cornerbax
From what I recently found out the AFIB could also be contributing to the Mitral Valve issue getting worse as the strain on it is greater because of the AFIB. Regardless, I still want/need to know definitively on my Mitral Valve before proceeding with any possible Ablation. It's so difficult to find good info on the differences of Mild/Moderate or even Severe.

Are there any specific symptoms one might have with SEVERE they would not have with Mild or Moderate? As I mentioned, I have NEVER had any chest pain, i've NEVER been Dizzy (with Afib/Mitral Valve or anything else), i've never passed out, i've only been Short of breath like being out of shape which I am. I have been diligently working on losing weight (which I have) and cutting out alcohol. The worst symptoms I ever had were when I had the severe reaction to Flecainide and Propafenone.

At this point I will get definitively clarity on the Mitral Valve and go from there.

As I understood it, it was the Mitral Valve regurgitation making the Afib worse, not vice versa. And, within 6 weeks my regurgitation was labeled Moderate, Moderate to Severe, and Severe. During the Mitral Valve repair with a MitraClip, the TEE reported it as Severe. The three levels of regurgitation reported came from an EP, a cardio-thoracic surgeon, and an Interventional cardiologist—go figure! It seems to be a judgment call. I didn’t notice a change in symptoms as the regurgitation progressed (probably because the change was slow) although after the repair I had more stamina.

I have read the same thing you mentioned but I believe what I read was very specific to "SEVERE" mitral valve regurgitation, not mild or moderate. From what I understand, if AFIB gets corrected and the heart is in normal sinus rhythm for months after, there is a remodeling that occurs and corrects the Mitral Valve. Also, at the same time the Atria gets corrected and isn't enlarged any longer. I don't want to quote or mention any names but someone who works with the highest regarded doctor on this forum was one of the people who told me this. One of the Hospital Cardiologists also told me this during my 3 day stay being monitored on Sotalol.

At this point, I need to know definitively the specifics on my Mitral Valve before deciding the next steps to take. This is a link I believe that goes over some of the things stated to me on this matter.

[www.ahajournals.org]



Edited 1 time(s). Last edit at 07/03/2023 09:03PM by cornerbax.

Cornerback- which cardiologist do you see at the group for your mitral valve prolapse? I think they all are good but I have a favorite. Dr Janet Wei is absolutely fantastic. She is generous with her time, has unlimited patience in answering questions about your mitral valve prolapse and very thorough . I moved out of California and out of all the things I miss, having her as my cardiologist is top of my list. Dr Shehata may not primarily address your mitral valve as part of his arrhythmia specialist interests. His interest is afib and he is involved with their pacemaker clinic. As I said, it’s an umbrella system. Their general cardiologists address heart issues and their EP afib,, pacemaker, etc issues.

Good luck

Hey Susan, I haven't seen specific cardiologist for the MVP because it's been dismissed multiple times and not mentioned on several occasions. I see Janet Wei has great reviews as do most at Cedars, so I can definitely inquire. There is great info in this thread. As Carey and many others have stated countless times, finding a "Maestro" level Ablationist is imperative. This was my goal from the beginning...to find an EP extremely experienced and where i'd have the greatest likelihood of success the first time.

The MVP concern is one that I will get addressed. I equate it to fixing a broken Sprinkler when there is a main pipe leading to that sprinkler that is broken. My focus/goal is to fix the broken Pipe first, NOT the sprinkler. I don't know in my case at this time what the pipe and what the sprinkler is, or even if there are multiple concerns at this point, but I am going to find out before I do anything. The last thing I would want to do correct the Mitral Valve right now if it doesn't need correcting. I also wouldn't want to get an ablation if the Mitral Valve should be addressed first. I will do my best to find and consult with someone who specializes in this area and see what there thoughts are. It's probably ideal to get another Echo since the last one was done in Late January.

Whatever I find out, i'll update this post/thread and thanks for all that contributed and responded, I appreciate the great advice.

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cornerbax
It's probably ideal to get another Echo since the last one was done in Late January.

You will get a better view with a TEE (transesophogeal echocardiogram), though it may be harder to get someone to do that.

Thank you Daisy! It sounds unlikely my PCP would be able to do a TEE? Im guessing I should try to find a few local quality cardiologists and call around to see where I can get the more detailed Tee done?

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cornerbax
Thank you Daisy! It sounds unlikely my PCP would be able to do a TEE? Im guessing I should try to find a few local quality cardiologists and call around to see where I can get the more detailed Tee done?

A PCP could probably order it though it needs to be done in a hospital as they usually knock you out with propofol because they are putting the echo probe down your throat--so a cardiologist would normally order it. I had one done with only a lidocaine spray down my throat and it was exceptionally unpleasant. I have having one done at TCAI in Austin next week to check my Watchman and they will use propofol, thankfully! The esophagus is the best viewing window for the heart cause of proximity.

That does sound unpleasant lol. I will check this out as it sounds like it's the best option to see what's going on.

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cornerbax
I will check this out as it sounds like it's the best option to see what's going on.

When my standard echo came back showing severe regurgitation, my EP then ordered a TEE to get a better look.

Yes and I would absolutely do that before doing anything related to any ablation or mitral valve. Over the last few days my heart rate at rest has been overall better than it has for months. From what the responses have been it may be normal sinus rhythm with Pacs.

Over 4 months my resting heart rate was never as low as it has been within the last week and it's possible I may know why but I will see if it continues first before mentioning it. Anyway, not sure how that plays into all of this im just saving my most recent ecgs for my EP to see their thoughts.

Cornerbax
“Hey Susan, I haven't seen specific cardiologist for the MVP because it's been dismissed multiple times and not mentioned on several occasions.”

I’m surprised because my MVP is only mild and they initiated treatment by having me on a BB and yearly echoes with follow ups. Obviously everyone is different and my preventative follow ups may have been based only on my situation. That said you need to see a cardiologist who is on board to meet your needs.

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I’m surprised because my MVP is only mild and they initiated treatment by having me on a BB and yearly echoes with follow ups. Obviously everyone is different and my preventative follow ups may have been based only on my situation. That said you need to see a cardiologist who is on board to meet your needs.

The only info from 5 doctors in total that I got was in 10-12 years I "may" need to get the Mitral Valve "tightened." That was the exact wording from a 40+ year Doctor in the hospital. They aren't specialists on MVP and after all of the great info here, I will absolutely be PROACTIVE on this to know definitively, even if it means getting the TEE, etc. to know. At this point, i'm awaiting Dr. Natale's view of my ECHO's and will go from there after I hear back.