Aortic Valve Replacement

[al]

I am a 52 year old male who has been followed for 30 years for aortic valve reguritation.  My last echo three months ago indicated I believe that something has increased by 2 mm.  I have another repeated echo in 2 weeks to determine if the change was due to operator error or if the increase was real.  I  am seeing a new cardiologist (18 months) since the Dr. I was seeing for 20 years moved away.  I was using both vasotec and inderal and it was keeping the reguritation in check.  In fact it was actual improving. I was taken off the medications with this new cardiologist to only zestril. I have no symtoms ..ie shortness of breath. Twenty years ago I was scheduled to have surgery and then obtained a second opinion and the second opinion cardiologist suggested that we treat my high blood pressure with medication.
The questions:
1.  Would / does the beta blocker help in this type of valve problem.
2.  How significant is the 2mm increase
3. My understanding is that from a durability point of view the mechanical valve is perferred but has the problem of requireing blood thinners. The homograft and the procine is second/third in durability but requires no blood thinners. The question is if one is on blood thinners and later requires a second valve,a bypass or another type of operation isn't this more of a problem and risk vs the homograft and its replacement.
4.  I have heard that there is a clicking sound with the mechanical valve...is this correct ? and how bad is this ?
5. A colleage of mine has his aortic valve (reguritation) repaired at the Cleveland clinc using the minimal evasive technique and is extremely pleased.  He was 70.  Is this preferable even if the valve has to be replaced in the future ?

6. If and when a need a valve I plan to have it done at the Cleveland clinic assuming my HMO approves.  I know Rochester NY hospitals perform valve replacements but it appears the clinic has more experience. What arrangements are possible while one has surgery to stay in the area or is this typically required.

I am extremely apprehensive about this type of operation, potential problems and would welcome any support/input from others in how to deal with this...physically and mentally. It seems whenever I see a new cardiologist, surgery is not far behind.

thanks

al

[CCF CARDIO MD - DLB]

1. It can help symptoms, but does not treat the valve problem per se.
2. If you are referring to an increase of 2 mm in the size of the aorta, that would be a lot. A beta blocker would be helpful if this is the situation.
3. If you are a candiadate for a homograft, I would favor this. The blood thinners would not be a problem for repeat surgery though (they would be stopped before the surgery)
4. Yes there is a clicking sound that you can hear and people very close to you may hear. Patients almost always get used to this. I have encountered only one or two patients who were really bothered by this, but they had other issues as well.
5. It is certainly better form a cosmetic viewpoint and may speed your recovery. It would not be a problem for the future.
6. You could stay in one of the hotels adjacent to the Clinic if you would like.

[Rob]

Hey Al,

I know where you are coming from.  I had an aortic valve replacement at the Cleveland Clinic in March of thins year.  Like you, I was very apprehensive about this having been followed for 20 years.

Everything went very well.  I chose the homograft and I am very happy with the outcome.  Nine months later I feel great and would not have know that I ever had surgery except for the relatively small (4 inch) scar.  Don't get me wrong, the surgery was a big deal, but the recovery was rapid, and the long term result looks good.

Take your time, and make a choice that suits you.

Rob

[noel]

AL Re  Mechanical  Valve  

  I  had one inserted 9  years ago  and I have never looked
back Thank God. My quality of life has improved  to a remarkable degree.
  Best Wishes

[Gail]

It has been 6 mos. since I had a mechanical valve replacement.
I had a porcine valve done 11 years ago at age 34.
The only option left for me was machanical as my cardiologist does not want me to undergo another surgery through the sternum.
The clicking does indeed seem very loud at night when all is quiet. I used an air cleaner for white noise for quite awhile.
I don't really hear it any other time. But at night it's very present. Am I getting used to it? I suppose. I get freaked out when it begins to beat really fast or irregular. I tell myself to breathe normally and calm down and it does start to click back to normal. I was also found to have mitral regurge and am taking prinivil to lower my blood pressure to give me as much time as possible before another surgery. He didn't fix it at the time because he said I was at death's door when I was admitted. My valve was leaking badly after having a cardiac cath done a week before. I was given a fluid overload and went into congestive heart failure.
The mitral valve can be done through the rib so I won't need to have my sternum opened again.
I had my surgery done at Stanford by Dr.C. Miller.  I am thin and the sternum wires are protruding and bothering me. He said I can have them removed soon and I will do that. I will have to go off coumadin for a couple days and they will use heparin I guess. My coumadin level is finally stablized and I need more than they thought. He says I have a good liver! I don't notice bleeding more when I cut myself. I have noticed that my nose is almost always bloody. So I need to talk to my Dr about this.
I was only in the hospital 5 days after surgery. I would say the worst part is when they remove the chest tubes. It was pain and fear all rolled into one and I am good at taking pain. After surgery I got tired of sleeping on my back and it is a great milestone when you can turn and sleep on your side! Oh the small things in life. Anyway I am almost back to normal, have returned to aerobic class and feel like I have a normal heart, really.
It's amazing what they can do!
Good Luck to you.

[TINA]

I had my AVR on Nov 3rd,2000. I chose the mechanical valve because they are more durable and I'm in no hurry to do this again! I am a slim person, and I do hear the valve clicking. But oddly enough, I only hear it intermittently. I do feel my heart beating stronger sometimes this bothers me at night. For that problem, I sleep with either the TV or music on.

[Aleta Hess]

I had a aortic valve replacement 1 1/2 ago.  They had to put a metal valve in. I also had a 7 centimeter aneurysm at the top of the main aorta and i had an aneurysm on two of the veins that lead out of he aorta to the neck they were 2 centimeters in size.  The drs. told me i was a walking time bomb. I was only 41. I had felt fine but didn't really no how sick i was .  I was always tierd and short of breath because i was born with a hole in my heart. It had healed on its own when i was little. So i just got used to becoming tierd and out of breath easy.But i also found out when i had an echo before surgery that the valve was bicuspid instead of tri cuspid.  Didn't not no that through all the things that i had was i was little.  So this had caused alot of my problems.  But i had surgery and am doing good. But having a terrible time with my blood trying to get it regulated. I am on blood thinnner. The metal vavle is nosy but i got used to it. Sometimes it  bothers me but as my dr said thats fine but when you don't hear it worry.  I have trouble with blood clots. They keep going through my eyes.  But if they could get the blood thinned just right or somewhat they say that will help.

[SYDNEY]

Have you looked into a Ross Procedure?  My husband had a Ross done almost two years ago at the age of 49.  It has, in his case, combined the benefits of mechanical and natural.

Here are two web sites that provides a wealth of information on the subject:

http://www.hsforum.com/stories/storyReader$1469

http://maelstrom.stjohns.edu/archives/ross-procedure.html

I hope this information is helpful to you.  

[Brent Dean]

hello Al I definately know where you are coming from.  I have had 3 open heart operations my first at 7 and a half months old then they replaced my aorta valve at 10 and then again 14.  I am curently 25 have not had it replaced since however did have a pacer implant at 23.  They are currently doing more tests because I have been having problems lately.  If you would like to talk further you can contact me at ***@****

[17 year old Andrew]

I am seventeen years old.  I was born with aortic stenosis and had a balloon procedure when I was five to correct the narrowing.  It created a small regurgitation problem.  I have been monitored yearly since I was five.  This past summer, I was told that I would have to have my aortic valve replaced.  It was a scary procedure and it took away from my senior year in high school.  However, just two months after the operation, I felt better than every.  I have a ton of energy and I look and feel like a normal person.  I had the mechanical St. Jude valve for its longevity.  Good luck.