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Heart Disease (Expert Forum)
Aortic Insufficiency
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
Aortic Insufficiency
by Don__0__0, Aug 30, 1998 12:00AM
My 21 year old brother was recently diagnosed with Aortic Insufficiency. His doctor is suggesting surgery to replace the valve with a metal valve. I was wondering if you know of any other alternative to surgery, and also, if you could provide me more information regarding this particular subject. I appreciate any help you could give me. Thank you.
Doctor's Answer
by CCF CARDIO MD APS, Aug 30, 1998 12:00AM
_
Dear Marissa,
Firstly, for most heart valve lesions/abnormalities there comes a time when the only option is surgery or else one is taking great risks for developing heart failure which itself leads to morbidity and mortality (suffering and death), as well as risking death itself. So suffice it to say that there comes a time in all valvular disease of the heart where surgery is the ONLY option. The timing of surgery has a lot to do with the echocardiography(ultrasound of the heart)findings; simply put, the worse the valvular lesion, the more strain put on the left ventricle, and the valve abnormality needs to be surgically fixed prior to that strain causing permanent damage to the left ventricle (main heart pump.)
As for alternative surgerical procedures, there is one very important one that I hope is considered in your young brother, and that is VALVE REPAIR. This is a fairly new surgical technique that only some surgeons can perform; we of course have a lot of experience here at the Cleveland Clinic with valve repair.
Valve repair is not 100%successful and it is likely that the young person will need a reoperation at some point in the future to replace the valve. The advantages to valve repair where you maintain the structural integrity of the patients' heart all many and beyond the scope of this forum, suffice it to say that our cardiovascular surgeons and cardiologists do not let a patient go to the operating room for valve surgery without at least considering the option of valve repair (there are a few exceptions of course but in young patients this is not the case.) An echocardiogram done in the OR immediately after the repair
tells the cardiovascular surgeon whether or not the repair has been successful so that if not s/he can retry or simply just replace right then and there. Our surgeons and cardiologists usually give the patient an idea of whether or not it will be repairable prior to going to the OR.
Now to address the 'replacement' issue, basically there are two types of valves to replace with: one is a tissue or bioprosthetic valve and the other is a mechanical valve made of plastics and metals. The advantage of a mechanical valve is that it can last forever (so long as it does not get infected or become dysfunctional), but with a mechanical valve the patient is forever on a blood thinning medication called coumadin/warfarin that prevents the body from forming clots on the valve. So the advantage of a tissue valve is that one does not need to take a blood thinner at all, however these valves in general last 10 years on average, and rarely any longer which would mean multiple reoperations in someone as young as 21(the risk of morbidity and mortality)rises with each successive operation.
So I hope you understand from all this that this is not only a complicated decision that should involve patient and physician opinion but also is very individualized, especially when dealing in aortic valve abnormalities, vs. mitral valve problems. Please have your brother and family discuss the option of repair vs replacement with the cardiovascular team that is involved in his care. Keep in mind that not all surgeons have been schooled in valve repair.
I hope this information is useful. Information provided in the heart forum is for
general purposes only. Only your physician can provided specific diagnoses and therapies.
Feel free to write back with further questions. Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please
call 1-800-CCF-CARE or inquire online by using the Heart Center website at
www.ccf.org/heartcenter. The Heart Center website contains a directory of the
cardiology staff that can be used to select the physician best suited to address your
cardiac problem.
