Hey, I got to post :-)

[Konopka1955]

Hi Doctor,  If you would be so kind as to answer several questions I would be very grateful.  I had a prior MI in 1992 an ICD Inplant in 2001 for NSVT and SVT which is now under control through meds.  Last year they discovered 3/3+ mitral valve leak - 50% leakage - I go for echos every 6 mos.  I recently had my 6 mos echo - I'm not sure I feel confident that this kind of test gives the best 'picture' of when to have surgery.  The surgeon said if I go below 50% EF or hit 55 mm on left ventricle enlargement (ESD) OR show symptoms - then he recommends that to be the 'time' for surgery but it is my decision.  I'm presently asymptomatic..  Everything I've been reading says you don't want to wait to long or the enlargement will not decrease after surgery.
Q1. Do you feel that the ECHOCARDIOGRAM is best test to be for indication for when surgery is necessary?  
My last echo said my left ventricle was enlarged to 51 mm - but my doc said its a +/- 5 mm so its ok as my previous one was 49 mm last July.  So being just 4 mm away - I'm wondering if I'm already at 55 or perhaps I'm 44 !!  
Q2.Is that normal to have a +/- 5 mm on echo tests?
Q3.Would a second opinion differ if taken from another hospital and another tech - depending on who and where you go and different echo equipment?
The surgeon said in all probability I can't be 'repaired' and will need a mechanical valve.
Q4.Does CCF perform 100% success in repairs as far as leakage?  
Q5.Is it common to need mitral surgery when you have no symptoms and is that the 'best' time for surgery - before symptoms apear?


Thanks

[CCF-M.D.-RCJ]

Konopka1955,

Thanks for the post.

Q1:"Do you feel that the ECHOCARDIOGRAM is best test to be for indication for when surgery is necessary?"

The echo needs to be coupled with clinical judgment, but yes, we rely on the echo to help guide us as to when surgery is necessary.

Here is a quote from the ACC guidelines:
(http://www.acc.org/clinical/guidelines/valvular/dirIndex.htm)
"The timing of surgery for asymptomatic patients was controversial, but most would now agree that mitral valve surgery is indicated with the appearance of echocardiographic indicators of LV dysfunction. These include LV ejection fraction <0.60 and/or LV end-systolic dimension >45 mm"

Q2:"Is that normal to have a +/- 5 mm on echo tests?"

I believe that this is larger value than what we report.

Q3:"Would a second opinion differ if taken from another hospital and another tech - depending on who and where you go and different echo equipment?

It sure might.

Q4:"Does CCF perform 100% success in repairs as far as leakage? "

You know the answer to this ... nothing in life is 100%.  The possibility of a repair varies depending on the patient's other factors and the cause of the leakage.  Certainly, our surgeons have more valve experience than anywhere else in the world, and repair is our preferred method when possible.

Q5:"Is it common to need mitral surgery when you have no symptoms and is that the 'best' time for surgery - before symptoms apear?"

It is not uncommon to need mitral valve surgery prior to the onset of symptoms.  The best time to have surgery is prior to the onset of any marker of LV dysfunction, like a dropping EF or expanding ventricle.

The guidelines would support proceeding with surgery in an otherwise healthy person with an LVESD of 51 mm.

Hope that helps.

[kayl]

Congratulations on getting through!

[Momto3]

I am so happy to see that you were able to post your questions. Your persistence has paid off!! We are all anxious to hear what the good doctors have to tell you. I am in a similar situation as you and have been told that MV surgery is probably in my future, but it is anyone's guess as to when. It's that whole matter of timing. I am also female, 46, and have 2-3+ MVR, but I have not run any races. Well, unless you count life itself...lol!! Up until about a year ago, my echos have always showed normal EF. It's a really long story, but the short of it is: My EF dropped and the doctors (many of them) determined that the drop was due to very frequent pvcs. I was in persistent bigeminy, etc. Anyway, after only 3 months on antiarrythmics, the echo showed 10% improvement in EF!! YEAH!! However, because of the side effects from the meds, and the fact that I would have needed to stay on them for life, I opted for an ablation.  Next month, I am going for another echo and keeping my fingers crossed for continued improvement. If the EF does not go back up to normal, I'm wondering if my doctor and I will be back to discussing MV surgery...YIKES! I supposed time will tell. I know that my doctor is right on top of this, but I can't help but wonder as I wait for the latest results. Good luck to you!!!

[Momto3]

Yup, 3 kids!I know ALL ABOUT the college experience! My oldest graduated in Dec 2002 and is teaching part-time and tutoring while she tries to get a full time teaching job! I thought that is what the degree was for, BUT, there are not as many openings as one would think. Lots of teachers staying on the job longer. That's another story! Next one graduates in June (Finance and Marketing) and I don't think it will be as difficult for him to get a full-time job. Last one will grad from community college in May and then on to a 4 year school! I am all tuitioned out!!

The people I have met on line have been so helpful. It's great to be able to talk to others who know exactly what I'm talking about. I know what you mean about studying "too much", gets me even more confused too! I've had pvcs since my early 20's and they went crazy in the last 5-7 years, but still not a problem, medically. You are SOOO young to have had a heart attack! That must have been so scary! From what I understand the frequency of pvcs is not normally of medical concern, except for in rare situations (like mine, I guess..lol). For me, they led to cardiomyopathy and now I'm waiting to see what new test shows. Seems so confusing at times.  

Glad to hear that one of your ablations was successful, and that you have had some success with the others. I am so fortunate that my ablations were successful. I get some "speedups", so I'll see what my doctor says next month. Yep, we've definitely gotta laughing, cuz otherwise, it would be tears all the way!
Good for you for staying on top of things....

I'm not sure if my heart is enlarged. TEE in 2000 said normal EF and no enlargement. Last year, I was so overwhelmed with tests and appointments that I kinda stopped asking my usual million questions. The report in Dec. 2002 said "evidence of a cardio-myopathic process in the entire left ventricle; EF 40%" YIKES!!! Because of some other factors, my doctor is certain (or as close as one can get) that it was from the pvcs.

I started resistance training (weights) about 6 weeks ago and I'm hoping that it will help my endurance. I used to use the treadmill, but I backed away from it because of being tired and uncomfortable. I'm working on getting back to exercising more...We have SO MUCH SNOW that I can't really walk outside, but there's always the treadmill!! Great talking to you. Email me if you want to talk more. Thanks for your exercise tip...I'll keep working on that! As far as running after the kids, nope...not any more. Now, I'm running from them...HAHAHAH!! Just kidding, they are great!!

Connie

[CCF-M.D.-RCJ]

Thanks for the vote of confidence.  Please remember that my comments don't substitute for your doctor -- talk to him/her.