Management of Asymptomatic Severe Chronic Organic Mitral Regurgitation LVEF > 60% and LVESD < 45 mm NoYes Atrial fibrillation or sPAP > 50 mmHg at rest NoYes * valve repair can be considered when there is a high likelihood of durable valve repair at a low risk Surgery (repair whenever possible) Follow-up* Severe asymptomatic organic MR