ARC Journal of Clinical Case Reports Volume 5, Issue 4, 2019, PP 1-5 ISSN No. (Online) 2455-9806 DOI: http://dx.doi.org/10.20431/2455-9806.0504001 www.arcjournals.org ARC Journal of Clinical Case Reports Page | 1 Progression and Challenges of Medical Treatment in Severe Functional Mitral Regurgitation: Case Report of 41-Year-Old Woman I Made Sutha Saskara 1* , Ida Bagus Rangga Wibhuti 2 , Bagus Ari Pradnyana Dwi Sutanegara 2 1 Faculty of Medicine, Udayana University, Bali, Indonesia 2 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia 1. INTRODUCTION Symptoms of Mitral Regurgitation rarely happen in the acute onset of the disease. Symptoms usually develop over time with the progression of left ventricle worsening due to the left ventricle can’t compensate for the volume overload or increase in the effective orifice area.[1] Management of Mitral Valve Regurgitation is focused primarily on the repairment of Mitral Valve by surgical procedure, either in asymptomatic or symptomatic patients.[2] As in the deprived socioeconomic population, this is not always the case. A high number of cases and lack of access to adequate surgical facility often present as a challenge for surgical option. However, when surgery is less considered, there is limited evidence regarding medical treatment effectiveness on mitral regurgitation patient. Therefore, we present a case of early diagnoses of an asymptomatic patient that hopefully could provide better insight and understanding in the progress and management of asymptomatic mitral regurgitation patients. 2. CASE REPORT Forty-one years old woman admitted on referral to our clinic on 12 th March 2019 with asymptomatic severe mitral valve regurgitation. The overall condition of the patient is good, well- nourished and in no acute distress. On examination, she was asymptomatic, and we found a 4/6 grade murmur holosystolic best heard at the apex. There was no history of heart or metabolic disease from her family. She denied smoking and only drink alcohol about 1-2 glass over the weekend, about 2-3 cups of coffee a day, and energy drink 1-2 cans a day after she finished her shift. She worked as a pantry cook assistant at a international cruise ship since 2002. History of using any intravenous drug injection denied by the patient. *Corresponding Author: I Made Sutha Saskara, Faculty of Medicine, Udayana University, Bali, Indonesia, Email: suthasaskara@unud.ac.id Abstract Introduction: The management of Mitral Regurgitation that still focuses heavily on surgical procedure, proves a challenge in deprived socioeconomic status. Case Presentation: We report a case of an asymptomatic forty-one years old woman referred with severe mitral regurgitation. Initial echocardiography shows that the patient has a severe mitral regurgitation. Later she underwent serial of follow-up echocardiography while administered oral medications for three months. In the latest evaluation she was found to have a significant improvement in lesion. Discussion: Despite the promising result, there is a challenge in early surgical intervention because of the limitation in experienced and advanced surgical centre as a prerequisite. When an adequate facility isn’t available, medical treatment could help with the management of the valve insufficiency. However, there is still limited studies regarding the benefit of long-term medical therapy in severe valve insufficiency. Conclusion: Medical therapy for mitral regurgitation could play a role in a setting where an adequate surgical facility is not available and watchful-waiting approach is assigned to the patient. Keywords: Mitral Insufficiency; Asymptomatic Mitral Regurgitation; Mitral Valve; Echocardiography; Transthoracic Echocardiography; Transoesophageal Echocardiography; Magnetic Resonance Imaging; Medical Treatment; Valve Repair