ACE and hydrops fetalis: The use of medical therapy for chronic MR has been largely non-conclusive and controversial.10 Most were small studies involving angiotensin converting enzyme (ACE) inhibitors and beta-blockers in degenerative MR.10-12 Guidelines on valvular heart disease recommend medical therapy for HF (ejection fraction < 50%) in chronic MR (class IIa, level of evidence B).7