Mechanical Valve Increased Gradient

Hi, I'm 42 with two AVR's. Last one was a St. Jude Mechanical two years ago. I just got back from my cardiologist for a follow up to an echo I had done due to having chest pain, which has gone away. As a matter of fact my cardio doesn't hear the murmur he heard two weeks ago. But he still wants to do a TEE next week to get a better look at my valve. He said that a clot may have broken off and went harmlessly through my body, or it could be something else. He said my gradient has also increased.

I'm not quite sure what that means. The valve they put in me was actually too small for my body. But it was the only one that could fit. And I'm wondering if that could be the problem? He also, unfortunately in front of my wife, said guys like me die young because of mechanical valve complications. But could having no chest pain for the past ten days and no sound of a murmur be good news? Or does the increased gradient mean I'm heading back to the OR again.

Thanks in advance for answers!

[kenkeith]

Gradient pressure is the result of stenosis (narrow orifice).  With a narrow opening, the pressure needs to be increased to pump blood through the opening.  The increased pressure causes the heart's chamber to remodel, and this increased size will reduce contractility over a period of time.

An increased chamber size to compensate for the increased gradient pressure may adjust to other system factors and never be a problem.  I believe the comment made by the doctor was inappropriate and not necessarily true. The problem according to your post the valve was to small from the start!  A too small valve will cause stenosis.

Hope this gives you an insight, and helps you to consult with your doctor regarding stenosis of the valve opening.  Your system may adjust to compensating factors better one day than the next so there cannot be conclusion in the short term.  Take care,

Ken

[paulwk]

Thanks Ken! My doctor really is a great guy. I think he is just overworked and wasn't thinking. I'm hoping he meant that young guys, who die because of mechanical valves, is usually because they throw a clot or something else. I'm not sure if that's true or not, but I'm hoping that's what he meant.

I guess I find it weird that the chest pain and murmur are just all of sudden gone. But the increasing gradient is still there. I guess I'll find out how bad it is next week. I'm not exactly anxious for OHS #3. The last one was a doozy to recover from.