Associated Press / March 3, 2005
Study urges timely surgery for symptomless leaky heart valve

People with severely leaky heart valves that cause no symptoms, a
situation thought to be relatively harmless, actually are in danger of
dying and should consider surgery to get the problem fixed right away,
a new study suggests.

Such people are five times more likely to die of a heart problem or
develop heart failure or an irregular heartbeat than those with mild
leakage, researchers at the Mayo Clinic reported in today's New England
Journal of Medicine.

Their study involved the mitral valve, which connects the upper left
chamber with the heart's main pumping chamber. If the valve's two flaps
don't close tightly, blood can leak back into the upper chamber when
the heart contracts.

Most people don't feel anything, but if it gets worse, they can develop
shortness of breath, fatigue, dizziness, and palpitations.

Doctors can detect the condition by listening to the heart, but usually
don't recommend surgery to repair or replace the valve unless it causes
symptoms or damages the heart itself.

The Mayo researchers used a relatively new ultrasound technique to take
measurements of the hearts of 456 patients who had leaky valves but no
symptoms. They found that the size of the hole in the valve was the
strongest predictor of how the patient would fare. Without surgery,
those with bigger holes, about the width of a pencil, did the worst.

"When it's severe, it's fixable. And we can determine when it's severe
now with new techniques," said Dr. Maurice Enriquez-Sarano, who led the
study.

Of the estimated 2.7 million Americans with notable leakage, about
600,000 are probably candidates for early surgery, Enriquez-Sarano
said.

Study participants were enrolled between 1991 and 2000. All had leaky
heart valves without symptoms and no other heart problems. Their
disorder was classified mild, moderate, or severe based on the volume
of their leakage and the size of the valve hole.

Participants were monitored and treated independently by their own
physicians. Updated information on the patients was collected by the
researchers in 2002.

Their findings showed that age, diabetes, and the valve hole were
strong predictors of survival.

Catherine Otto, of the University of Washington in Seattle, said the
study is a big step forward, because physicians can use the measurement
to tell patients what to expect if they have a valve problem. But she
said the measurements are challenging to make, and the data apply only
to those without any other heart problem.