2nd May 2024

A 68-year-old woman with a history of hypertension and diabetes presents to the cardiology clinic with fatigue and shortness of breath on exertion.

A 68-year-old woman with a history of hypertension and diabetes presents to the cardiology clinic with fatigue and shortness of breath on exertion. She has a history of chronic primary mitral regurgitation (MR). An echocardiogram shows severe MR with a left ventricular ejection fraction of 55% and left ventricular end-systolic diameter of 42 mm. She has no history of atrial fibrillation or pulmonary hypertension. What is the most appropriate next step in management?