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Surgery for mitral valve leakage
You are quite right that once the heart function is affected by mitral valve leakage, it may be soon necessary to consider a mitral valve repair. However, the precise timing of an operation is always a question of judgment. I would look at the rate of change in heart function, f.i. between the last few evaluations. This is usually done with serial echocardiograms. If none, I'd probably recommend against surgery for now.
If a significant change is present since the previous test, I'd consider surgery at this point to prevent worse. As far as the operation itself is concerned, it should be a disease specific mitral valve repair, not a valve replacement if at all possible:
This requires a surgeon with extensive experience!
Hope this helps,
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