After Open Heart Surgery

[Glam0urgirl]

My husband is 31 years old & just went through open heart surgery to repair his mitral valve. He had severe regurgitation. Since before he went in for the surgery he has been taking Cardizem 120 & even after surgery they kept him on the medication with 1 baby aspirin a day. They said they would monitor him for the next few months and decide if he can come off or not. Since then he had his echo cardiogram & they reported his heart muscle function has decreased. And i would assume his ejection fraction is lower then they would like for a man of his age. I know the ejection fraction right after surgery was 46% & before surgery it was 55% (they did an echo cardiogram before being discharged) .. I am wondering if the ejection fraction can be reversed ? or is this common after someone having surgery ? They started him on Toprol XL 25. The cardiologist says its the lowest dose. I am very very very concerned about heart failure. He is in great shape & feeling the best he has ever felt .. what gives ?

[CCFHeartMD27]

It sounds like you and your husband have been through a lot.  It also sounds like he had quite advanced mitral regurgitation with a decrease in heart function even before the operation.  It is not uncommon for people to have a decline in left ventricular function after operation for advanced severe mitral regurgitation.  Your husband should talk with his cardiologist about his medications regimen to make certain that he is taking the right drug cocktail (ACE-inhibitor, beta blocker, etc.) and avoiding drugs that could worsen heart function (diltiazem is not recommended in patients with decreased left ventricular function).  It sounds like your husband is not symptomatic, which is great news.  Consider being seen by a heart valve or heart failure specialist for follow-up and management. Seeking a second opinion is always a good option!

[ed34]

Sorry to intervene but I get so angry at this. Cardiologists know how inaccurate an echo can be for evaluating EF yet they still insist on scaring patients for some reason. This has been known for over ten years. Here is one such example of a study done, and there are many. I quote from the American College of Cardiology "Ejection fraction from precontrast echo and MRI differed by ≥10% (EF units) in 23 patients versus 0 after contrast". 110 patients were in this example, and 23 patients (virtually a quarter) had their EF quoted incorrectly. If you want the echo to be accurate, you must inject the patient with a contrast first to make the chamber easier to measure. In all those 23 cases, the EF was UNDER stated but it can happen both ways. I've had numerous echoscans since 2007 and my range has been 50-65%. In one day I had 2 scans and the EF was 50 in the first and 60 in the second. Every time I have an Angiogram, it is more accurately calculated at 70%. So 50% is FAR short of 70%. Saying all that, it is still quite common for EF to drop after mitral valve surgery and they have no idea why it happens. It still doesn't remove the problem of accurate EF figures in the first place, so at least you know what you're dealing with. I'm lucky, my cardiologist doesn't take any notice of EF from an echo unless it's very low and then he orders a contrast version.

[Glam0urgirl]

Thank you so much for getting back to me. The cardiologist has taken him off the cardizem and put him on metroprol(at least i think that's how you spell it) .. i am just wondering if the ejection fraction can ever be built back up or will this be a constant problem for him ? could this just be from having surgery ? Ughhhh i'm so worried.