From the Guidelines
Myxomatous valve disease management should prioritize a comprehensive assessment of mitral regurgitation severity and symptoms, with treatment decisions guided by the most recent and highest quality evidence, such as the 2022 systematic review of clinical practice guidelines and recommendations 1.
Key Considerations
- Myxomatous valve disease is a degenerative condition affecting heart valves, most commonly the mitral valve, where the valve tissue becomes floppy and stretchy due to abnormal connective tissue.
- Management depends on severity and symptoms, with asymptomatic patients with mild disease requiring regular cardiac monitoring every 1-2 years without specific medication.
- For those with moderate regurgitation, ACE inhibitors like enalapril (5-20 mg daily) or beta-blockers such as metoprolol (25-200 mg daily) may be prescribed to reduce cardiac workload, as recommended by guidelines such as the 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease 2.
- Severe cases with significant regurgitation or symptoms like shortness of breath, fatigue, or palpitations may require surgical intervention, either valve repair or replacement, with the decision to operate based on preoperative testing and symptoms, and intraoperative transesophageal echocardiography used to evaluate the results of mitral valve repair immediately after cardiopulmonary bypass 2.
Diagnostic Evaluation
- Transthoracic echocardiography is the most commonly used imaging test for mitral regurgitation, with transesophageal echocardiography often needed to better define morphology and MR severity, and essential for guiding transcatheter therapies for MR 3.
- Multidetector computed tomography has become the standard to assess whether transcatheter valve replacement is an option, and cine cardiac magnetic resonance has been recommended by recent guidelines to quantify MR severity when the distinction between moderate and severe MR is indeterminate by echocardiography 3.
Treatment Approach
- The treatment approach should be individualized based on the severity of mitral regurgitation, symptoms, and patient characteristics, with a focus on reducing morbidity and mortality, and improving quality of life.
- Endocarditis prophylaxis is no longer routinely recommended for most patients with myxomatous valve disease unless they have a history of endocarditis or prosthetic valves, as stated in guidelines such as the eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities 4.
From the Research
Myxomatous Valve Disease
- Myxomatous valve disease is a condition characterized by the degeneration of the valve tissue, leading to mitral regurgitation or other valve-related issues 5, 6.
- The disease can affect both the mitral and aortic valves, although it is more commonly associated with the mitral valve 7, 8.
- Myxomatous degeneration is a non-inflammatory process that disrupts the fibrosa layer of the valve, leading to the accumulation of acid mucopolysaccharides 8.
Diagnosis and Management
- Diagnosis of myxomatous valve disease is often made using two- and three-dimensional echocardiography, as well as magnetic resonance imaging 7, 6.
- Surgical repair or replacement of the affected valve is often necessary to treat the condition, with techniques such as annuloplasty and leaflet repair being used 9, 5.
- Percutaneous approaches, such as clipping the leaflets or inserting bioprostheses, are also being developed as less invasive alternatives to open-chest surgery 9.
Clinical Features and Outcomes
- Patients with myxomatous valve disease often present with symptoms such as dyspnea, cough, and peripheral edema 8.
- The condition can lead to complications such as embolic events, obstruction of the mitral orifice, and heart failure if left untreated 7, 8.
- Surgical treatment has been shown to be effective in improving symptoms and outcomes, with good response to treatment and low rates of mortality and reoperation 5.