Progression of TR following MVR and Malignant Hypertension

I'm a 36 year old female, 8 months post-op MVR, malignant hypertension, with the following concerns: obviously, the malignant hypertension, for which I have been seeing a hypertension specialist at the University of Michigan for since 2007, and the persistence of the following symptoms: extreme fatigue, shortness of breath with minimal exertion, peripheral edema, pulmonary congestion, cough, and palpatations since surgery. I’ve had two echocardiograms and one transespophagal echocardiogram since MVR all indicating moderate to moderately-severe tricuspid regurgitation, mild aortic regurgitation, stage 2 diastolic dysfunction, mild to moderate pulmonary hypertension (42 to 69 mmHg) and 42% ejection fracture. I’m on the following medications: Lasix, Lisinopril, Spirolactone, metopropol, libatolol, norvasc, potassium, and . BP averages between 165/100 - 245/155. Again, I’ve been seeing a Hypertension Specialist since 2007 and all tests have been ran and repeated numerous times. No cause can be identified. My concern is obviously the malignant hypertension and what it is doing to my heart and other organs but also the progression of TR since MVR. Prior to MVR, TR was trace. I’ve read much on the subject of TR following left-sided heart surgery and am aware that often it progresses instead of correcting itself following the correction of the left sided lesion. I also know that TR following MVR/AVR has a poor prognosis. My question is, should I be concerned with it’s progession at this point? If not, when should I? Also, will my hypertension exassperate all these issues? I sincerely thank you in advance for your time and consideration. I also should add that I sought two opinions for the mitral valve regurgitation, one from your institution, that told me that there was nothing anatomically wrong with my MV and that it was functional in nature. Less than two months later, I had my mitral valve repaired at the University of Michigan and it was almost not repairable.

[Lee Kirksey, MD]

Hello
Its sounds like you have a fantastic team taking care of your very challenging problem and you appear quite knowledgeable as well. You have summed up the challege and expectations of correcting mitral valve pathology in the face of TR. I would be interested to hear what your team has told you about the progression of your symptoms since surgery. Without seeing your multiple post operative tests including your pulmonary pressures, it is somewhat of a guess to try and determine the cause of your progressive symptoms. I would suggest that the presence of persistent hypertension will contribute to the gradual worsening of symtpoms. I agree that worsening TR is of concern. It would be helpful to know if you have had catheterization with measurement of heart pressures

The best thing that could happen would be a sudden discovery of a treatable cause of your hypertension. That might cause your symptoms to stabilize.