EF of 40% after AVR

[babapadam]

Hello,
My father (60 years old) underwent an aortic valve replacement along with double-bypass 9 months ago. After he was moved to the room from the ICU, he developed orthopnea and swollen feet.
The doctors moved him back to the ICU for 2 days and this went away. He was then discharged and is now recovering at home. He was taking Lanoxin and diuretics and did not have any swelling or breathlessness. So after 3 months the doctor stopped these medications (without checking the EF).

He went for his checkup this month (9 months after surgery) and his echo shows an EF of 40%. The doctor also mentions "Mild LV Dysfunction". So now the doctor has put him back on Lanoxin and diuretics. Is this heart failure where the prognosis is poor? Will the EF improve after 9 months post-surgery? His EF was 53% before surgery and I am very concerned. Please advise.

Thanks,
-Babapadam


This discussion is related to AVR + CABG.

[babapadam]

Thanks kenkeith. Good to hear that you have recovered well. The echo report does mention "dilated LV" and mild mitral regurgitation. However, the new aortic valve is intact.

[kenkeith]

Left ventricle functionality should be preserved subsequent to CABG and valve replacement.  There is often is no improvement of the EF if it was abnormal before the surgery...surgery is oftened contraindicated for a patient with low EF.

Heart failure is an EF 29% or below.  Six years ago, I was in ICU for several days with congested heart failure.  The EF was 13-29% and blood backed up into the lungs causing edema (shortness of breath, dry cough, fast heart rate).  The underlying cause was an enlarged left ventricle that decreased pumping strength, and with medication the heart returned to normal size and EF is now 59%.

An EF of 40% shouldn't cause heart failure, but symptoms indicate a heart problem. It could be the heart hasn't adjusted to the surgery and requires more time...probably should have stayed on a diuretic longer...an increase of blood volume due to increased fluids burdens the heart, and the additional burden may not have given the heart enough time to heal.
Does the echo indicate an enlarged left ventricle? Any valve leakage?