A 59 year old man with severe myxomatous mitral regurgitation is asymptomatic, with a left ventricular ejection fraction of 45% and an end-systolic diameter index of 2.9 cm/m2. The most appropriate treatment is:
A. Mitral valve repair or replacement
B. No treatment
C. ACE inhibitor therapy
D. Digoxin and diuretic therapy
Correct answer : A. Mitral valve repair or replacement
Surgical treatment of severe mitral regurgitation is recommended even if the person is asymptomatic when the LV ejection fraction drops below 60% and there is progressive LV dysfunction.