Can Mechanical Mitral Valve prolapse or move out of position?

[kayl]

This is my fourth question and my last, I promise.  I am a 50 year old female with Rheumatic Heart disease.  I've had two open heart surgeries on the Mitral valve. Open commissurotomy and valve replacement in 1990 St. Jude Mechanical valve.  I have chronic atrial fibrillation , AV Node ablation in 1999, am pacemaker dependent.  I was diagnosed with pulmonary hypertension in December 2003 by Right Heart Cath.  A second Right Heart cath and left heart cath was done in March 2004.  There was confusion as to what kind of valve I had (tissue or mechanical).  The second heart cath showed a mitral valve area of 1.1,the pressure gradient across the valve was 11, left atrial pressure of 18, severe tricuspid regurgitation and moderate aortic regurgitation and pulmonary hypertension.
On fluoroscope, the mitral valve looks like a large button on a jacket facing out.  The cardiologists opinion was that no surgery was possible as there was too much to be done.  I was told to walk on level ground. Is it possible for a mechanical valve to move out of position?  If my valve is out of position, can it be corrected?  Is there a surgeon at the Cleveland Clinic who might be able to help me?

[CCF-M.D.-MJM]

Kayl,

This sounds like a complicated problem.

1. Is it possible for a mechanical valve to move out of position?

Yes it is possible for a valve to move out of position.  It can happen very soon after surgery as well as after years of use.

2. If my valve is out of position, can it be corrected? Is there a surgeon at the Cleveland Clinic who might be able to help me?

I will answer these at the same time.  Whether or not it can be corrected depends on the type of problem and your physical condition.  Unfortunately it is true that some people are too sick for surgery and the risk of complication is too high.  However, that is definitely a question that cannot be answered online.  That will take a detailed examination by a cardiothoracic surgeon and a cardiologist.

Many of our patients come to the Cleveland Clinic because other physicians thought their surgeries were too dangerous or complicated. Sometimes we agree and don't operate, often we think there is something we can fix to improve quality of life or even extend life.  My advice to you is to seek a second opinion.  We would love to see you at the Cleveland Clinic and I hope we can help.  All of our cardiothoracic surgeons have taken cases similar to what you describe and there is actually no individual surgeon I would recommmend.  Call 216-444-2200 and ask for the cardiology appointment desk. Ask the appointment desk how you can meet with a surgeon and a cardiologist for evaluation.

I hope this helps and good luck.  Thanks for posting.

[DottyCece]

Kayl,

So sorry to hear of all you problems.  I can relate a bit.  I had a mitral valve replacement in May of 2003 and was never okay after that procedure.  I had symptoms of heart failure and atrial fib/flutter.  After months of complaining and at a time when I gained about 15 pounds in one week (water), I sought out another cardiologist I knew well.  She recognize the problem immediately as being the mitral valve.  Though I had severe regurgitation in the tricuspid valve, this was being caused by the prosthetic mital valve.  The heart cath showed pulmonary hypertension, high wedge pressures and PA pressures.  Recommendation was to redo the mitral valve prosthesis, put a ring on the tricuspid and then do ablations in both atrial for the atrial fib/flutter.  I had the redo in April.  They found that the valve was functioning correctly but upon opening the valve they found over half of the mitral valve opening covered by soft tissue.  It was believed that the area wasn't prepared well for seating the first prosthetic valve which caused in essence a mitral stenosis which could account for most of my symptoms.  I had an excellent surgeon the second time and am doing very well surgically speaking. The ablations were a failure so I had an AV nodal ablation this past week which I really didn't want but I couldn't cope with the high heart rates anymore.  I would like to believe that there would be some group of surgeons that could help you.  I would recommend my second surgeon who has a reputation as being one of the best when it comes to valves but I am not sure where you live.  

Don't give up.  Seek opinions from the experts..i.e. Cleveland Clinics, Mayo Clinics etc.  You are very young to have all these problems.  I would be interested in chatting with you about the AV nodal ablation and its outcomes.  I still regret having to do this.

[kayl]

Thank you so much for your comments.  It does seem that we have had some of the same experiences.  E-mail me at ***@****.  I look forward to hearing from you.