My daughter is 21, thin, a non smoker, has signficantly leakage in mitral valve. recent te test:strong heart. had rheumatic fevr is surgery inevitable?

It Depends: Time is a very helpful tool. If its is severe, then she will probably need surgery at some point, but it's impossible to predict when. If it's mild/moderate, the valve could remain stable. So, she should have an echocardiogram (ultrasound of the heart) at least once a year, and it does not have to be a trans-esophageal type.

Likely needs surgery: Severe mitral valve regurgitation will eventually lead to heart failure and death. Mitral valve repair in patients with severe mr and no symptoms ir recommended. Minimally invasive techniques are available and long term results are good.