Diagnosis and mechanism
Primary or secondary regurgitation and rheumatic or calcific stenosis are different problems. The documented diagnosis and cause shape which questions and procedures belong in the discussion.
Your Incision Should Be Your Decision™
Mitral valve second opinion
Before a mitral procedure, know what your records support.
A cardiac surgeon and cardiologist independently review the records and imaging required for your case, then co-sign one report explaining the diagnosis, timing, and only the paths relevant to you.
What happens next: A member of our team will call within 2 business hours. During business hours, a same-day conversation with a cardiac surgeon or cardiologist may be arranged only when clinically appropriate and a physician is available.
- 2
- independent physician reviews
- 1
- co-signed written report
- 24 hr
- only after all required records and imaging are received and confirmed complete
No referral or travel required for the written review. With your authorization, the records team can help obtain what is needed. The written review includes two independent physician reviews and one co-signed written report; it does not include a live physician consultation. The Consult plan includes everything in the written review plus one live consultation with one reviewing physician. Pricing is shared during your complimentary discovery call.
Case-specific reviewMitral valve
The question is not simply “repair, replacement, or a catheter procedure?” It is “which paths fit this diagnosis, this anatomy, and the whole heart?”
Message Us about my decisionOne clear way to begin
You do not need every record—or the right medical words—to begin.
Tell us whether repair, replacement, TEER, balloon treatment, or continued follow-up was discussed—and which part of the recommendation still feels unclear.
No referral · no travel · no obligation to purchase- 01
Tell us what you were told
A sentence is enough. Include what was recommended, what is scheduled, and what still feels unresolved.
- 02
We identify what the case needs
A member of the team helps determine which records and images matter and can help with retrieval after authorization.
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Choose the support that fits
The written review always includes a cardiac surgeon, a cardiologist, and one co-signed report. Live physician time is optional.
First, name the valve problem
A leaking mitral valve and a narrowed mitral valve are different decisions.
Mitral regurgitation and mitral stenosis can share symptoms, but they do not share one treatment pathway. Cause, anatomy, severity, symptoms, heart response, and available procedures must be reviewed separately. Continue following your treating team’s instructions while seeking clarification.
Severity, symptoms, and trajectory
Symptoms, serial echocardiograms, pulmonary pressures, rhythm, exercise tolerance, and changes in left-ventricular size or function help explain why intervention is—or is not—being discussed now.
Anatomy and procedural fit
Leaflet motion, prolapse or restriction, annular dimensions, calcium, coaptation, commissures, valve area, and gradient can change which surgical or transcatheter approaches are technically reasonable.
The rest of the heart
Coronary disease, atrial fibrillation, tricuspid or aortic valve disease, and ventricular dysfunction may favor a combined operation, a staged plan, or a different sequence of care.
For mitral regurgitation
Repair, replacement, and TEER do not share one treatment algorithm.
The right comparison starts with the diagnosis. Primary MR, secondary MR, and mitral stenosis require different reasoning. The review identifies which paths are clinically relevant to discuss—and why.
Repair
For primary degenerative MR, surgical repair is generally preferred over replacement when a successful and durable repair is expected. Repairability depends on the lesion, tissue quality, calcium, prior treatment, and experience relevant to that anatomy. A record review cannot promise that repair will be possible or durable.
- Which leaflet segments and mechanism are involved?
- What makes a durable repair more or less likely?
- Does the proposed program fit this anatomy?
Replace
Replacement may be considered when a durable repair is unlikely or inappropriate because of rheumatic disease, heavy calcification, tissue destruction, prior procedures, or other anatomy. When replacement is relevant, prosthesis choice, anticoagulation, durability, lifestyle, and future procedures belong in the same discussion.
- Why is replacement being proposed over repair?
- Mechanical or tissue—and what follows from each?
- Can other cardiac problems be addressed at the same operation?
TEER + other
TEER is not a universal alternative to surgery. It may be considered for selected patients with severe symptomatic primary MR, suitable anatomy, and high surgical risk; and for selected patients with severe symptomatic secondary MR despite optimized guideline-directed heart-failure therapy and cardiac resynchronization when indicated. Candidacy also depends on ventricular, pulmonary-pressure, and anatomic criteria assessed by the treating multidisciplinary valve team.
- Does the mechanism and anatomy support TEER without an excessive gradient?
- Has guideline-directed therapy—and CRT when indicated—been optimized?
- What would trigger a change from monitoring to intervention?
Mitral stenosis follows a different fork: repair and TEER framing for regurgitation should not be carried over. The treating valve team may instead discuss surveillance, medical or rhythm care, balloon commissurotomy, selected transcatheter approaches, or surgery depending on cause and anatomy. Another reasonable step may be to complete the workup or revisit timing. WHITEGLOVEMD does not diagnose, prescribe treatment, or replace the clinicians directing your care.
The anatomy and durability view
A technically possible procedure is not the same as a durable strategy.
A useful review looks beyond the immediate recovery to residual regurgitation or stenosis, recurrent disease, reintervention, prosthesis implications, and whether the rest of the heart should be treated at the same time.
Repairability is anatomy-specific
Posterior, anterior, bileaflet, restricted, calcified, rheumatic, and previously treated valves do not carry the same technical questions. A review should name what the available imaging does—and does not—show.
Durability matters as much as feasibility
A procedure may be technically possible without being the most durable path. Residual regurgitation, stenosis, recurrent disease, reintervention, and the consequences of a failed strategy deserve attention.
Primary and secondary MR require different reasoning
In primary MR the valve itself is diseased. In secondary MR, ventricular or atrial remodeling can prevent otherwise structurally normal leaflets from meeting normally. The role of medical, device, catheter, and surgical treatment can therefore differ.
Replacement opens another decision
If repair is not considered durable, mechanical and tissue prostheses bring different trade-offs involving anticoagulation, durability, bleeding, thrombosis, lifestyle, and future procedures.
Combined treatment can change the value of surgery
Bypass, atrial fibrillation surgery, tricuspid repair, or another valve procedure may sometimes be addressed during the same operation. That can alter a comparison with a single-lesion catheter procedure.
Your priorities belong in the record
Recovery, anticoagulation, future procedures, caregiving, work, travel, and tolerance for uncertainty are legitimate inputs to shared decision-making.
Independent dual review
The operating-room view and the cardiology view—on the same review record set.
Both plans include both independent reviews and both physician signatures. The physicians confer before the report is finalized.
Cardiac surgeon
Repairability · replacement strategy · operative access · combined procedures · lesion-specific program fit
Cardiologist
Mechanism · severity · ventricular response · TEER anatomy · medical and rhythm context · surveillance
WHITEGLOVE Insights™
Your mitral decision, organized around your case.
The report is written for patients and families, but grounded in the complete source record, current evidence, and two physician reviews.
See a sample reportYour mechanism.
Your options.
Your next questions.
01Diagnosis + mechanism02Anatomy + severity03Timing + heart response04Relevant path + next questions
One readable reviewThe findings that change the decision, with uncertainty made visible.
Cardiac surgeonCardiologist
Your current clinical picture
The documented diagnosis and cause, symptoms, serial testing, heart response, treating team’s plan, and the findings driving the discussion—clearly tied to the source record.
Paths relevant to this diagnosis
The benefits, burdens, technical considerations, and unanswered questions for repair, replacement, TEER, balloon commissurotomy, monitoring, or other paths only when clinically relevant.
Anatomy and procedural fit
Leaflet involvement, motion, coaptation, commissural, annular and subvalvular findings, calcium, valve area, gradients, and the limits of the available imaging.
Surgical-risk context
The current STS ACSD operative-risk estimate when applicable, with verified inputs, calculation date, missing data, and model limitations made visible. Other models are discussed only when documented in the source record.
Your anatomy—not someone else’s
Patient-facing explanations connect the relevant echo, TEE, catheterization, and imaging findings to the decision in front of you.
What may still be missing
A practical check for unresolved imaging, measurements, testing, or clinical context to discuss with the treating team.
Surgeon and center fit
Lesion-specific repair experience, valve-program capability, geography, practical considerations, and reliable public outcomes when requested and available.
Questions for the next conversation
A concise set of questions and next steps to bring back to the physicians who know you and will provide your care.
Ready for an independent read?
Put a cardiac surgeon and cardiologist on the same review record set.
The written-review option includes both independent physician reviews and one co-signed written report. Live consultation is not included at this level.
What may still be missing
Repairability and timing are only as clear as the record behind them.
A missing study does not automatically mean care was inadequate. It means the limits of the available review should be visible—and turned into useful questions for the treating team.
Transthoracic echocardiography
MR mechanism and severity, chamber size, ventricular function, pulmonary pressure, other valves, and serial change—not only one number from one study.
TEE or advanced valve imaging
When clinically relevant, transesophageal echocardiography can clarify leaflet segments, coaptation, calcium, repairability, and TEER anatomy. Its absence is a question—not automatically an error.
Coronary assessment
Whether coronary disease is present and whether bypass or another coronary strategy changes the choice or sequence of treatment.
Rhythm, other valves, and right heart
Atrial fibrillation, tricuspid disease, aortic valve disease, pulmonary pressure, and right-ventricular status may change a combined plan.
Risk-model inputs
The clinical and laboratory variables needed for a defensible estimate, plus the limits of every model.
Symptoms, therapy, and functional context
Exercise tolerance, congestion, medication strategy where relevant, kidney and pulmonary status, frailty, and what has changed over time.
Evidence, with its limits visible
Guidelines and risk models inform the review. Physicians interpret them.
2025 · ESC/EACTSGuidelines for management of valvular heart disease2020 · ACC/AHAGuideline for management of valvular heart diseaseSociety of Thoracic SurgeonsAdult Cardiac Surgery Database operative risk calculatorOfficial EuroSCORE siteEuroSCORE II model and stated limitationsAmerican Association for Thoracic SurgeryAATS patient-specific cardiac surgery risk calculator
Risk estimates describe modeled outcomes for patients with similar inputs. They do not predict an individual result and do not replace clinical judgment.
How it works
From scattered records to a clearer valve conversation.
The report is delivered within 24 hours only after all required records and imaging are received and confirmed complete. Time spent gathering missing records is outside the 24-hour window.
- 01
Message us about the decision
Tell us what you were told, what is already scheduled, and what still feels unresolved. No referral or records are needed to begin.
- 02
We help assemble the record set
Upload what you have or authorize the records team to help gather the echocardiography and TEE when available, catheterization, imaging, notes, labs, and proposed plan required for the review.
- 03
Two physicians review independently
A cardiac surgeon and cardiologist examine the same record set received and confirmed complete for this review from different clinical perspectives, then confer.
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Receive one co-signed report
The report is delivered within 24 hours only after all required records and imaging are received and confirmed complete. Time spent gathering missing records is outside the 24-hour window.
Mitral valve second opinion FAQ
Questions patients and families ask before a mitral valve decision.
When is a mitral valve second opinion useful?+
A second opinion can be useful when repair, replacement, TEER, or continued monitoring is being discussed and you want to understand the mechanism of regurgitation, the timing, repairability, alternative approaches, individual risk, or whether another cardiac problem changes the plan. It should not delay urgent or time-sensitive care directed by your treating team.
Can a mitral valve be repaired instead of replaced?+
Sometimes, but not every valve is durably repairable. The answer depends on the actual mechanism, leaflet and annular anatomy, calcification, tissue quality, prior procedures, and experience relevant to that lesion. The review organizes what the available imaging suggests, what remains uncertain, and why repair or replacement is being proposed without promising a repair result.
What is the difference between primary and secondary mitral regurgitation?+
Primary mitral regurgitation begins with disease of the valve apparatus, such as prolapse or a flail leaflet. Secondary regurgitation occurs because changes in the ventricle or atrium prevent the leaflets from meeting normally. The distinction matters because the roles of repair, replacement, TEER, medical therapy, rhythm treatment, and monitoring can differ.
Is mitral stenosis reviewed differently from mitral regurgitation?+
Yes. Mitral regurgitation is a leaking valve; mitral stenosis is a narrowed valve. Mitral stenosis raises different questions about cause, valve area and gradients, symptoms, rhythm and clot-prevention context, anatomy, and whether monitoring, balloon commissurotomy, or surgery is relevant. Repair and TEER language on this page applies to regurgitation only when supported by the record.
Could TEER, such as MitraClip, be an alternative to surgery?+
TEER is not a universal alternative to surgery. It may be considered for selected patients with severe symptomatic primary MR, suitable anatomy, and high surgical risk; and for selected patients with severe symptomatic secondary MR despite optimized guideline-directed heart-failure therapy and cardiac resynchronization when indicated. Ventricular status, pulmonary pressure, anatomy, and assessment by the treating multidisciplinary valve team also matter. A catheter procedure is not automatically better or less appropriate than surgery.
Will the review compare mechanical and tissue valves if replacement is proposed?+
Yes, when replacement is a relevant option. The report can organize trade-offs involving durability, lifelong anticoagulation, bleeding and clotting considerations, lifestyle, pregnancy considerations when relevant, and possible future procedures. It does not prescribe a prosthesis; the final choice belongs with you and your treating physicians.
What records are needed for a mitral valve second opinion?+
The exact record depends on the decision. It commonly includes transthoracic echocardiogram images and reports, TEE images and report when performed or clinically relevant, catheterization or coronary assessment, clinical notes, laboratory results, medication history, rhythm information, and the proposed treatment plan. With your authorization, the records team can help identify, request, and organize what is needed.
Who reviews my mitral valve case?+
A cardiac surgeon and cardiologist independently review the same record set received and confirmed complete for the review, then confer and co-sign one WHITEGLOVE Insights™ report. Both perspectives are included at every service level.
How quickly is the written report delivered?+
The report is delivered within 24 hours only after all required records and imaging are received and confirmed complete. Time spent gathering missing records is outside the 24-hour window.
How much does a mitral valve second opinion cost?+
WHITEGLOVE Insights™ includes two independent physician reviews and one co-signed written report; it does not include a live physician consultation. WHITEGLOVE Consult includes everything in the written-review plan plus one live consultation with one reviewing physician. Pricing is shared during your complimentary discovery call. WHITEGLOVEMD is a direct-pay service and does not submit insurance claims.
Does WHITEGLOVEMD replace my valve team?+
No. WHITEGLOVEMD provides independent educational decision support and medical-record review. It does not diagnose, prescribe, perform procedures, provide emergency care, or replace the physicians responsible for your treatment.
Not emergency care.
Do not delay urgent or time-sensitive treatment while waiting for WHITEGLOVEMD. If you may be experiencing a medical emergency, call 911 immediately.
A clearer next conversation starts here
Get clear on what your mitral valve records support.
Message us about what you were told, what is scheduled, and what still feels unresolved. We’ll explain the next step and help identify the records and imaging needed for review.
The written review includes two independent physician reviews and one co-signed written report. The Consult plan includes everything in the written review plus one live consultation with one reviewing physician. Pricing is shared during your complimentary discovery call.
A member of our team will call within 2 business hours. During business hours, a same-day conversation with a cardiac surgeon or cardiologist may be arranged only when clinically appropriate and a physician is available.