: : My husband is a healthy active 41 year old. He was diagnosed with MVP with thickened valves in 1991. Since then he has had annual echocardiograms. During the summer of 98 he wasn't feeling well for quite a while (months). He had his annual echo on July 21, they didn't see significant change from previous echos. He went to the Dr with fever and aches on Aug 6, was prescribed antibiotics. He felt better then the symptoms returned, he went back on the 19th. They did a blood culture, it was positive for strep bacteria. He was started on an IV antibiotic course on the 21st. He went back for another echo on the 22nd. And was positive for vegitation. They reviewed their previous echo, and saw the start of vegitation on the valves at that time. So he had the bacteria on them for quite some time. He had a TEE done at the completion of his antibiotic course.
: : The evaluation:
: : 1. The left atrium is enlarged, but there is no evidence of thrombus or spontaneous echo-contrast. Interatrial septum is intact.
: : 2. The right atrium is probably at the upper limits of normal.
: : 3. The left ventricle is at the upper limits of normal in dimensions. It appears normal systolic function with an estimated ejection fraction of 50-60%.
: : 4. The mitral valve is thickened and there is prolapsing of the posterior mitral leaflet into the left atrium and at the tip of the leaflet, there is a nodular and mobile structure consistent with a vegetation. In some views, the anterior leaflet may have a smaller mobile structure and possibly reflects vegetation, although it could also be part of a thickened myxomatous portion of the valve. The mitral valve has moderate regurgitation which is directed anteriouly towards the septum. There is no abscess formation.
: : 5. Aortic, tricuspid, and pulmonic valves appear normal.
: : 6. Pericardium appears normal.
: : We went back in for his annual echo in Dec. 98 and told that his Chordae had ruptured. It didn't seem to be a big deal to them. But, we are still confused. What determines when you need surgery? How many chordae are there? How does your valve work when it is ruptured? What are the risks of just leaving it as is?
: : Thank you for any help you can give,
: : Cindy
Yes, the stress test for the assessment of Mitral regurgitation (MR) that I
am speaking of is an echo done prior to and after stress on a treadmill or bike,
however it can be an echo done during infusion of a drug called dobutamine (reserved for
those unable to exercise.)
There is no doubt that this test would provide significant information in regards
to the timing of surgery for your husband, and it certainly should be done soon.
Cindy, you do not need to search for information or read about it before considering it,
rather, this is knowledge that the cardiologist should have and a test therefore that should
be considered if not offered to your husband. I believe you said that your husband has some
fatigue; again this could be a sign that the MR is worse or further along than you think and it
really is time to go to surgery, not wait 6 months. So stop doing literature searches so to speak
and go see a cardiologist who has vast experience in valve disorders and the timing of the surgery.
Keep in mind that a repair should be considered in every patient and whether or not the valve disorder is
described as congenital or thick, it does not matter, repair should be considered and at least attempted.
As I said before, repairs also need to be considered earlier in the course of the disease. I highly recommend
you and your husband seek an opinion here at the Cleveland Clinic, or at least at a comparable medical center.
The Cleveland Clinic did over 1,500 valve surgeries in 1998, and of the mitral surgeries, 80% of them were repairs, not replacements.
Needless to say, it is the surgeons decision both before and during the surgery regarding 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
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