New York Heart Association Classification of Heart Failure.

class 1:  no undue symptoms associated with ordinary activity and no limitations of physical activity.     class 11: slight limitation of physical activity, patient comfortable at rest.    class 111: marked limitation of physical activity, patient comfortable at rest.    class 1V: inability to carry on any physical activity without discomfort, symptoms of cardiac insufficiency or chest pain possible even at rest. 

In the Western Countries the most common indication for mitral valve surgery is due to Mitral regurgitation due to flail leaflets. The condition may be without symptoms for several years although the degree of regurgitation may be severe, and left ventricular dysfunction may have developed.  The optimal timing for mitral valve surgery has not been established.

The decision to operate and correct a valve abnormality will depend on whether the condition is life-threatening and to the what extent it has affected the person's life style.  In the case of mitral regurgitation, the desirability of surgery is usually determined by how severely the symptoms affect the patients life-style and how well they can be controlled by medical treatment.

      There was a study done in 1996 from the Mayo Clinic. They  evaluated the long-term morbidity, cardiac complications, and the effect of mitral valve surgery on the prognosis of patients with mitral regurgitation.   228 patients with mitral regurgitation due to flail leaflet were involved in the study.  143 of these patients had valve surgery, 107 of these being in NYHA grade 111-1V heart failure. Survival of those that underwent surgery was calculated at 79% at 5 years, and 66% at 10 years.

      CONCLUSION: The conclusion is that those with Mitral regurgitation have a significant excess mortality due to cardiac disease when treated medically. This is especially seen in those with a reduced left ventricular ejection fraction at time of diagnosis and those who have or develop heart failure.  Surgical correction of mitral regurgitation improves long-term survival, and so all patients considered to be low surgical risks should be considered for operative intervention.  Those patients with NYHA class 111 heart failure or above should be offered immediate surgery.

     An eight year's experience in 531 patients with mitral valve reconstruction surgery from New Delhi, India, 1997.  A total of 531 patients underwent reconstruction of the mitral valve for mitral regurgitation.  79% of these were aged under 30 years.  Ten patients have been re-operated on for residual mitral regurgitation.  Follow up on patients is 93% complete.  After 84 month the actuarial survival rate was 93.1% and event-free survival rate was 87.3%.   

     They concluded that mitral valve repair in the young rheumatic population is feasible, the probability of re-operation is low, and the symptomatic relief is gratifying.