A 59 year old man with severe myxomatous mitral regurgitation is asymptomatic. His echo shows a left ventricular ejection fraction of 45% and an end-systolic diameter index of 2.9 cm/m2. Which of the following represents the most appropriate mode of treatment ?

This man is asymptomatic, but his left ventricular ejection fraction is 45%, so the most appropriate treatment is mitral valve repair or replacement. Indications of surgical repair of mitral valve are patients who are symptomatic, asymptomatic patients with left ventricular ejection fraction less than 60% and/or end-systolic dimension increasing beyond 40 mmHg, recent onset atrial fibrillation and pulmonary hypeension (Pulmonary aery pressure 50 mmHg at rest or 60 mmHg with exercise). Ref: Harrison's Internal Medicine, 18th Edition, Chapter 237