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(Circulation. 1999;99:338-339.)
© 1999 American Heart Association, Inc.

Editorial

Timing of Surgery for Patients With Nonischemic Severe Mitral Regurgitation

Robert C. Schlant, MD

From the Emory University School of Medicine, Atlanta, Ga.

Correspondence to Robert C. Schlant, MD, Professor of Medicine (Cardiology), Emory University School of Medicine, 69 Butler St, SE, Atlanta, GA 30303.

Key Words: Editorials • surgery • mitral valve • regurgitation

Amajor problem in the management of patients with chronic, severe mitral regurgitation (MR) remains the timing of operative intervention. This is particularly true for patients with nonischemic severe MR, which in the United States is now most often due to mitral valve prolapse, frequently with a flail mitral leaflet. Surprisingly, some patients with this condition do not have undue fatigue or dyspnea during ordinary physical activity and therefore are in NYHA functional class I.¹ Patients are classified as functional class II when they have slight limitation of physical activity and are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain. Patients are classified as functional class III when they have cardiac disease that results in marked limitation of physical activity; although patients in functional class III are comfortable at rest, less-than-ordinary physical activity causes fatigue, palpitation, dyspnea, or anginal pain. Patients are classified as functional class IV when their cardiac disease results in inability to carry on any physical activity without discomfort. Symptoms of heart failure or of the anginal syndrome may be present even at rest and may increase if any physical activity is undertaken.

It is significant that this functional classification is based entirely on subjective symptoms. This was one of the reasons why this functional classification described in the sixth edition (1964) was replaced in the seventh (1973) and eighth (1979) editions of the NYHA Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. The most recent . . . [Full Text of this Article]

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