Q: I have been told that I need to have my mitral valve repaired. My cardiologist discovered that both leaflets are affected but I have no serious symptoms - intermittent irregular heart beat, tinnitus, fatigue and a little dizziness when I don't eat in the morning. I am unsure if I require surgery when I am feeling good but feel the need when I am not feeling too good. I have been on Altace and 81 mg Aspirin. I also have a moderately dialated left ventricle. What will happen if I don't get the valve repaired and for how long can I stay without repair?

A:The few findings indicated in your query suggest that your mitral valve is insufficient because the leaflets do not close properly. It is true that mitral valve insufficiency does not immediately or always call for valve repair or replacement. Whether or when they are needed would depend on the patient’s disability (tiredness, shortness of breath, exercise intolerance etc.) and the cardiac findings in ultrasonography, ECG and catheterization. It is well known that patients often unknowingly limit themselves and feel that they have little disability. Your cardiac findings would obviously have made your cardiologist suggest mitral valve repair. The “moderately dilated left ventricle” mentioned in your letter shows that the pumping ability of your heart is being stretched beyond acceptable limits by mitral insufficiency and the consequent pressure on the left ventricle to pump more. How long can you wait? No precise period can be given. All one can say is that the risk of mitral valve repair or replacement would keep increasing in proportion to the increase in your disability and the dilatation of the left ventricle.