From the Guidelines
Myxomatous valve disease management should focus on monitoring and symptomatic treatment, as there are currently no therapies to prevent disease progression in the valve leaflets, according to the 2014 AHA/ACC guideline 1.
Key Considerations
- The condition is characterized by a systolic billowing of one or both mitral leaflets into the left atrium with or without mitral regurgitation (MR) 1.
- Management depends on the severity of the disease and the presence of symptoms.
- Asymptomatic patients with mild disease can be monitored with echocardiograms every 3-5 years, while those with moderate regurgitation require annual echocardiograms.
Treatment Options
- Patients with symptoms like shortness of breath, fatigue, or palpitations may benefit from medications including:
- Beta-blockers (such as metoprolol 25-100mg twice daily) to control heart rate and reduce palpitations.
- ACE inhibitors (like enalapril 2.5-20mg daily) to reduce afterload.
- Diuretics like furosemide (20-80mg daily) to manage fluid retention.
Surgical Intervention
- Severe cases with significant regurgitation or ventricular enlargement typically require surgical intervention, either valve repair (preferred when possible) or replacement.
Prevention and Prophylaxis
- Endocarditis prophylaxis is no longer routinely recommended for most patients with myxomatous valve disease unless they have a history of endocarditis or prosthetic valves.
Monitoring and Follow-up
- Regular cardiac follow-up is essential to monitor for worsening regurgitation or ventricular dysfunction that might necessitate intervention, as the disease progresses slowly in most patients 1.
From the Research
Myxomatous Valve Disease Overview
- Myxomatous mitral valve disease (MMVD) is a chronic disease that progresses from mild to severe over years, causing mitral regurgitation 2.
- It is the most common cause of congestive heart failure and cardiac-related mortality in dogs 3.
- The disease typically takes several years to progress from mild, clinically silent myxomatous mitral valve disease to severe disease with signs of congestive heart failure 3.
Treatment Options
- Treatment strategies for MMVD change with the stage of the disease 2.
- Beta-blockers have a role in the management of many patients with valvular disorders, especially in the case of patients with mitral stenosis 4.
- Mitral valve repair is the procedure of choice whenever feasible and when the results are expected to be durable for degenerative mitral valve regurgitation 5.
- Surgical resection with mitral valve defect repair is the commonest remedy for mitral valve myxoma when mitral valve function can be preserved 6.
Diagnostic Approaches
- Two- and three-dimensional transthoracic and/or transesophageal echocardiography, as well as magnetic resonance imaging, are used for diagnosis of mitral valve myxoma 6.
- Regular, postoperative cardiological control is mandatory due to the fact that myxomas can recur 6.
Prognostic Indicators
- Some variables have been shown to be predictive of onset of congestive heart failure and might be useful to identify dogs that need more frequent monitoring and eventually treatment 3.
- Results from several controlled clinical trials are available concerning medical treatment of dogs with myxomatous mitral valve disease with or without congestive heart failure 3.