Age and mitral valve repair for moderate to severe regurgitation

[jazznman]

I am a 68 year old male whose first echo six months ago showed mild to moderate mitral regurgitation. Six months later (today) it shows moderate to severe. I have no symptoms and still jog 2 to 3 miles in 90 degree heatat about a nine minute mile rate.  

Can variables like lack of sleep , exercise immediately before the second echo, etc be responible for the newest reading? Related to that... do subsequent echo cardiograms ever show improvement even if no chsaanges have been made?
Finally, if my family longevity on the bad side is 76, is it worth me having the surgery? Or, should I take my chances that I 'll do as well as all my relatives who made it to 76 and had problems as bad or worse. Won't you still just make it to 76 or so if that's your genetic make-up.. Or does this type of surgery subvert the genetic component ahd allow you to live longer.
Thanks so much.


This discussion is related to Re: Mitral Valve Regurgitation and Surgery.

[ed34]

No I am not a Cardiologist BUT I have certainly read many papers which relate to the facts that I have given you. I don't know why you find it so hard to believe that research has shown that moderate to severe CAN progress quickly. No of course it isn't the case with EVERYONE, but how can you guarantee that you are not one of those? You can't.
You would be feeling very different if the valve was now being forced out of shape making surgery unlikely to be very successful, wishing it was done far sooner. I bet all those patients in those circumstances wish it was done sooner.
To me it's like saying "I have a 90% blockage in my LAD but it may never totally block, maybe killing me, so I will leave it". We all have choices and of course we can make wrong choices, including cardiologists. How many people go for an angiogram because a cardiologist believes there is a blockage, but none are found? you would be amazed. They are human like anyone else. I was told that a triple bypass would give me a normal quality of life, when I was pushing for stents. They refused the stents saying it wouldn't work, and a bypass would last the rest of my life. These were highly qualified cardiac surgeons and cardiologists too. So I did as was recommended, I went through a year of discomfort for a bypass that only lasted 3 months. Cardiologists are not seers, they are not superhuman either. They are all on a continuous learning curve in their careers. In the end, they agreed to stent my LAD and for 2 years now it has been fine.
The reality is, in just six months you went from mild/moderate to moderate/severe. This isn't long. If your left atrium enlarges, then the prognosis for a successful long term valve repair/replacement lessens.
A paper I read stated that research has shown, long term prognosis greatly improves if valve rectification occurs at the mild/moderate stage.

[jazznman]

Thanks. Two final questions. I'd appreciate anything you chose to tell me.

If surgery for 3+ was needed ASAP why would my cardiologist tell me to come back in 6 months to have the stress echo. My older brother, also a physician(and who also has 3+ mitral valve regurgitation) assures me that no reputable cardiologist would wait six months for a test if  a patient needed surgery ASAP. (BTW  the clinic is well known and much respected.)  

Secondly,doesn't your statement that "moderate" CAN lead to "serious" very quickly, indicate that such a progression is not always the case.Wouldn't it be foolish to order surgery without some other PROOF that I was among those whose condition would go from moderate to severe very quickly. I have known about my MVP with regurgitattion  since I was twelve. That's fifty six years.

I'm not trying to be quarrelsome... just interested in trying to  get as many questions answered as possible. JUst curious. Are you a cardiologist?  

Thanks for your help. I do take into account all you say.

[ed34]

I'm sorry, but collaterals have nothing to do with valve inefficiency. You are not suffering ischaemia, what you have is a mechanical problem and no matter how many arteries you have, this will not resolve the problem.
I strongly urge you to research valve insufficiency and look at long term prognosis. You do realise that your heart should be pumping blood through your aortic valve to feed your whole body, and not pumping a proportion of it back where it just came from?
When you suffer such things, I think it's important to look at the statistics, and  they show that valve repair is important asap. Latest papers published actually do not agree with the 90% because they have found if left until the moderate stage, the valve can very quickly go to severe and even cause death.
It's obviously your body and if you don't trust surgery and want to rely on guess work, then there's nothing I can do. I am simply attempting to give you the truth here and hope you make the right choice to carry on with a normal life.
Take care.

[jazznman]

I appreciate your taking the time to reply to my questions, though the tone of your  message is certainly disheartening. It seems based on the procedures you have already had done, you are a firm believer in the efficacy of surgery. I am not.

Frankly, I believe surgery is often over-prescibed. In  my case, all my relatives on my father's side had mitral valve regurgitation in addition to having smoked and drank  immoderately, been overweight, and burned the candle at both ends, Other than moderate MVR, I share none of their other problems. Even so, all reached their mid- seventies(my mother's side late eighties) in an era when such surgery was not often recommended,medicines were not as good, and far less  was known about heart disease..
Your judgment that my having no symptoms while jogging significant distances etc. is a sign my heart is working very hard, seems open to dispute. Isn't it just as possible that 35 years of jogging may have led to the formation of collateral arteries or an especially efficient heart?
Finally,even the AMA and cardiology groups are not unanimous in recommending surgery for those with moderate MVR. The slight consensus is on doing surgery on those with moderate MVR only if the liklihood of a successful outcome is 90% or better.
I have a feeling that MVP surgery except in serious cases  may improve the quality of life, but not not do  much to increase it.  
I'm curious what others feel.  Thanks again and good health.  

[ed34]

I am very shocked that your heart management team didn't recommend surgery at your first echo, rather than let things get this far. It is recognised that the progression from moderate to severe can be very quick. The fact that you feel no symptoms suggests to me that your heart is working very hard to compensate for the fact that there is mitral insufficiency. In reality, your heart will now start to enlarge and the muscle will weaken, causing heart failure. The high pressure in your left atrium will likely cause this to enlarge also, causing problems for a successful valve repair. Personally, I would lay off exercise until the surgery is done, your heart is working hard enough at rest. Valves can become inefficient through wear and tear or even a previous infection you've had. So, I don't think you can apply genetics and calculate your life expectancy. If I go through my family history over hundreds of years, life expectancy would have been around 30 to 40 if lucky. It is because of surgery such as this that you can push those boundaries. I very much doubt if you will reach 76 if you leave a mitral valve in a severe condition. There is also the risk of serious arrhythmia developing.
Have they booked a date for your surgery yet?
Sleep will have no effect on your valve functionality.