Sir.—I enjoyed reading the excellent editorial by Allen1 on mitral valve prolapse (MVP). As a long-time student of this subject, I agree with almost everything he said (ie, that MVP may be primary or secondary2; that MVP is a result of ventriculovalvular disparity3; that endocarditis prophylaxis is indicated for patients with MVP whether or not the clicks are associated with a regurgitant murmur4; that the diagnosis of MVP should be based more on results of auscultation than on results of echocardiography5; and that the physician should, under all circumstances, avoid overdiagnosing MVP6).
However, I disagree with his statement that mitral valve replacement is necessary if regurgitation is severe. Currently, mitral valve repair is the preferred form of surgical treatment for MVP with severe mitral valve regurgitation. In general, mitral valve repair is better than mitral valve replacement for the following reasons: (1) operative