It's not absolutely necessary to treat our patient's ventricular ectopy, as it has no adverse prognostic significance. However, it may continue to be disturbing to the patient in spite of reassurance.
If elected, the most appropriate therapy would be a beta adrenergic blocker that either suppresses the PVCs or makes them less noticeable to the patient.
Our patient
The patient's symptoms resolved with beta blocker therapy. Although surgery is not indicated in our patient, mitral valve prolapse with symptomatic severe mitral regurgitation is a common indication for mitral valve surgery. As will be discussed, surgical repair of the mitral valve involves a selection of various techniques to restore valve function to normal.
Myxomatous MVP with severe MR surgery - example
The surgery that follows is an example of surgical repair of a myxomatous mitral valve with marked prolapse causing severe mitral regurgitation.
Surgical exploration of the mitral valve from the left atrium reveals excessive tissue of the posterior leaflet.
By placing traction on the leaflets, the surgeon can evaluate their coaptation.
In this case, the redundant posterior mitral leaflet prolapses into the left atrium because one of the chordae has ruptured. The surgeon has made the decision to do a quadrangular resection of the mid portion of the posterior leaflet.
He resects this area and frees up a portion of the surrounding residual posterior leaflet to aid in the repair.
Sutures are now passed circumferentially around the enlarged mitral valve annulus to secure the annuloplasty ring that will later be used to secure the repair.
The annulus is now reapproximated at the base of the resected segment and residual leaflet tissue is sewn together.
Assessment of the repair reveals excellent coaptation of the anterior and posterior mitral leaflets with no residual prolapse.
The anterior mitral leaflet is now used to size the restored annulus.
The previously placed sutures are used to secure the annuloplasty ring in place.
Testing of the repair reveals excellent leaflet coaptation with no residual regurgitation.
Mitral annular ring
A mitral annular ring is usually inserted to help stabilize the repair. Transesophageal echocardiography (TEE) is an excellent technique to help guide the surgery. The TEE post repair follows.
TEE post repair
This is a systolic still frame of a 2-dimensional TEE at the level of the mitral valve in a long axis plane from another patient after mitral valve repair using an annuloplasty ring. It shows dense echoes that represent cross sections of the annuloplasty ring and the mitral leaflets. The myxomatous anterior mitral leaflet is elongated and the posterior mitral leaflet is shortened. In the real time study that follows, note the normal excursion of the thickened anterior mitral leaflet, the reduced excursion of the shortened posterior mitral leaflet and the normal leaflet coaptation.