NEJM: July 8 2010

There are a couple of good articles in this weeks NEJM, one in particular which I thought would be of interest to readers.

“Mitral regurgitation due to degenerative valve disease”  http://content.nejm.org/cgi/content/full/363/2/156 is part of the NEJM Clinical Practice articles which begins with a short vignette then a review of current evidence and guidelines. In this case the article talks us through the medical and surgical options for patients with degenerative MV disease and highlights the currently accepted best practice.

The article ends with a brief summary of the current recommendations for when patients should be offered surgical intervention:

Symptomatic or asymptomatic patients with chronic severe MR with evidence of LV dysfunction defined as an LVEF of 30-60% and a LV end systolic dimension of 40mm or greater

Asymptomatic patients with evidence of raised PA pressure

Asymptomatic patients with new-onset AF

The article notes that patients with severely reduced LVEF (<30%) are unlikely to benefit Asymptomatic patients with evidence of raised PA pressures

The articles states that endocarditis prophylaxis should be offered to patients with MV disease only after MV replacement (prosthetic or repair with annuloplasty) or where there is a prior history of endocarditis. A few years ago there was a trend for all patients with MV disease (ranging from those with so-called benign MV prolapse to those with chronic severe MR) to be offered prophylaxis but this has now gone out of fashion as re-highlighted here.