Timing of surgery in organic mitral regurgitation

Prompt mitral surgery decision
AF, atrial fibrillation; LV, left ventricle; MR, mitral regurgitation; PHTN, pulmonary hypertension; VT, ventricular tachycardia.
Severe mitral regurgitation
Symptoms or LV dysfunction presentYes
No symptoms and n LV dysfunction
    AF or VT or PHTNYes
    No AF, no VT, no PHTN
        Repairable = NoUsually no
            Massive MR (regurgitant volume ≥100 ml)Possible yes
            Pronounced left atrial enlargement
        Repairable = Yes and
            Low riskUsually yes
            High risk or severe comorbidityUsually no
Not severe mitral regurgitation
Regurgitant volume <45 mlNo
Regurgitant volume 45–60 mlUsually no
        VT or AF or LV dysfunction and repairable = yesPossible yes
        Other cardiac operation scheduled and repairable = yesPossible yes